This action might not be possible to undo. Are you sure you want to continue?
Five lifestyle decisions correct your
chemical imbalance so you recover
from depression naturally, even
when antidepressants have
failed. By a former depressive
who made a full recovery
W ¡ T H O U T
ME D S
5 lifestyle decisions correct your chemical imbalance
so you recover from depression naturally,
even when antidepressants have failed.
By a former depressive who made
a full recovery without drugs
MA R K MY E R S
HU G O P R E S S
T A O S , N M
¡O R ¡ U R T H E R HE ¡ P
For additional information on ending depression by mak-
ing lifestyle changes, and to see how you can get live, per-
sonal guidance and support, go to:
The information presented in this book is not intended to serve as a re-
placement for professional medical advice. Any use of this information is at
the reader’s discretion. The author and publisher specifcally disclaim any
and all liability arising directly or indirectly from the use or application of
any information presented here. The treatment approach advocated in this
book does not replace ongoing treatment. Do not abrubtly stop any other
treatments in deference to this approach. A health care professional should
be consulted regarding your specifc situation. If you are having suicidal
thoughts, dial 911 or call a physician immediately.
Copyright © 2008 by Mark Myers
All rights reserved. No part of this book may be reproduced in any form or
by any electronic or mechanical means, including information storage and
retrieval systems, without permission in writing from the publisher, except
by a reviewer, who may quote brief passages in a review.
Library of Congress Control Number: 2007939917
Library of Congress subject heading:
1. Depression, Mental—Popular works. 2. Depression, Mental—Alternative
To my darling wife Judy, the golden thread
in the fabric of my life. She walked into my
offce one day by pure grace, but once fate
made its contribution, I earned her love. That
is, she said she liked the look of my forearms.
C o n t e n t s
1. Lifestyle Changes Are Causing Your Depression.
Lifestyle Changes Will Cure It.
The one sure way out of depression
Five ordinary things are wrecking your buoyancy
Depression means physical illness is on the way
Why Americans are the most depressed people ever
How progress ushered in the Age of Depression
Why drugs or therapy haven’t fxed you
The best way to help a loved one recover
Ten ways that lifestyle changes are better than meds
2. How My Depression Ended 15
I had resigned myself to being depressed forever 15
My recovery began when I lost almost everything 16
A walk in the park was my frst step to recovery 17
How a church contributed to my recovery 18
How the best-tasting foods fght depression 19
From 175 to 142 pounds without really trying 20
I kept score against depression on a blackboard 22
I succeeded slowly, step by step 24
Research explained my recovery, even predicted it 25
How Pfzer uses doctors to spread misinformation 26
Big Pharma’s campaign against healthy habits 27
Why you’re fully capable of making thee changes 30
3. The Three Underlying Causes of Depression:
Nature, Nurture, and Furniture
The Titanic disaster explains why you get depressed 32
The supporting roles played by genes and childhood 34
The Bad Bulb Test reveals the deciding factor 36
Medical research points to the same chief cause 37
Scientists give us parts that solve the whole puzzle 38
The last undepressed generation in the U.S. 39
Why depression has doubled every 20 years 41
What’s behind the Amish immunity to depression 42
Study your own family to see the pattern 43
Defusing the time bomb that demolishes health 45
4. No Pill Cures Starvation 47
But if pills help, stay on them while you recover 47
Why doctors don’t take good care of depressives 48
Specialists are better, but not a whole lot better 50
Guess who sponsors the studies cited in drug ads 51
The U.S. government got to the truth about pills 53
Doctors and drug companies as faith healers 55
Drugs only turn black moods into gray ones 56
All the things the drug commercial doesn’t mention 57
Side effects, unpredictability, and wearout 58
Slow results, high cost, and proven dangers 59
We may not know about the worst dangers yet 61
Addicted to antidepressants, yet still depressed 62
Why You Can’t Talk Your Way Out of Depression
Psychotherapy can help, but rarely ends depression 65
Three limitations that hold therapists back 66
How a therapist can help you make lifestyle changes 67
Analyzing Freud’s lifelong depression 68
A 17th-century visionary who saw the true causes 69
6. Use It (Your Body) Or Lose It (Your Mind) 71
Why retired athletes often get depressed 71
Living from chair to chair 72
Medical studies: “Nothing works as well as exercise” 73
11 ways exercise protects you against depression 75
Exercise any way you want, but keep doing it 76
If you structure it now, you’ll do it later 77
Use peer pressure to motivate yourself 77
Pain isn’t the point, so make it a pleasure 78
Slow and steady wins the race 79
Make it a game even if you’re the only player 81
Humankind’s frst form of exercise is still the best 82
7. Escaping from Sleep-debtor’s Prison 85
You may be clueless about your sleep needs 85
We’re sleeping two hours less than they were in 1900 86
Taking off in a 747 while they’re still servicing it 88
Men and women need equal sleep but women get less 89
The two biggest sleep robbers and how to arrest them 91
A good night’s sleep without pills 91
Apnea: 18 million oxygen-deprived under-sleepers 92
When your job doesn’t square with your biology 93
Aches and pains and the royal pain lying next to you 94
Lifestyle changes correct sleep problems 96
Nutritional Recklessness 97
America’s other drinking problem: corn syrup 97
High-fructose: good for companies, bad for people 98
Sugar is a loan shark, and the payments can kill you 101
Eating better by the numbers—or by color 103
Cholesterol: bad for your heart, worse for your brain 104
The worst food ever: abominable, lethal trans fat 106
Seven little words that help end your depression 109
McDonald’s memo: “We don’t sell nutrition” 111
The best favors are in the most healthful foods 112
It’s a 5-million-year-old body; treat it accordingly 115
9. Re-joining the Human Race 117
Home alone: as harmful as smoking two packs a day 118
Togetherness improves both mood and health 119
Many of us have forgotten: We are all people people 123
Nine easy ways to stay shy and still connect 125
10. Getting Off Easy 133
Depression and addiction cause each other 133
Many dangerous mood-boosters are perfectly legal 135
McLean Hospital: “The U.S. is a nation of addicts” 138
Most people overcome their addictions without help 139
More subtle forms of addiction: the occupiers 140
Quitting is easy when you prepare correctly
Don’t let anybody tell you how or when to quit 145
The legitimate need that addiction serves 146
Addictions drop away when your needs are met 149
The depression cure that also cures addiction 150
11. Tortoises Recover Faster Than Hares 151
Any frst step is good as long as you take one 151
You won’t get far carrying two suitcases and a poodle 152
Time isn’t your problem, but carrying capacity is 153
Six ways to lighten your load for a new challenge 154
Ganging up with your friends against depression 157
How to form a winning anti-depression team 158
12. Becoming Unsinkable 161
Stronger protection than two anti-depression genes 161
Imagine a pill that could pull you out of an episode 162
Four reliable ways to stop depression after it starts 163
Setting aside the time you need to get well fast 165
Programming yourself to bounce back 169
My own self-rescue script 172
More tips for fast emergency recovery 174
13. You Were Born To Be Buoyant 177
Correcting 5,000 years of disastrous expert advice 177
Finally, enough data to make the true cause obvious 178
Knowledge is power—the power to end depression 179
A potent modern weapon: your capacity for change 180
14. Further Help 181
A Note about Notes 183
O N E
L i f e s t y L e P r o b L e ms A r e
C A u s i n g yo u r De P r e s s i o n .
L i f e s t y L e Ch A n g e s
Wi L L Cu r e i t .
Ba l a n c e d b r a i n c h e mi s t r y
c o me s f r o m b a l a n c e d l i v i n g .
our depression isn’t about what you think. It’s about
how you live.
Your low mood isn’t caused by how you feel, but by
the negative conditioning of debilitating habits.
You don’t get depressed because something depressing
happens. Unfortunate things do happen, and when they do,
you get depressed because of choices you made a long time
before misfortune knocked on your door.
Your episodes aren’t a normal response to stress. Stress
is the bale of straw that breaks the camel’s back, but what
makes the camel’s back breakable is the way you live.
Depression isn’t a brain-chemical imbalance. A chemical
imbalance is most assuredly involved in depression, but how
did it come about? Genes have something to do with it. So
does childhood history. But above all, unbalanced chemistry
is your body’s response to an unbalanced life.
Does it surprise you to hear someone say that your de-
pression is caused by something that’s entirely within your
control? It may be a new idea to you, and, indeed, is a new
one to many people. You won’t fnd a lot of experts or drug
ads saying it, though hundreds of studies confrm it
many doctors, in their heart of hearts, know it...
UP W ¡ T H O U T ME D S z
Deciding to live a little differently
is the only sure way out of depression.
In this book I’m going to ask you to jump several years ahead
of the experts, and make up your own mind about what’s
really causing your depression. It’s important to rely on your
own judgment here, because if you allow the weight of current
expert opinion to make up your mind for you, you’ll come to
the wrong conclusion. And the wrong conclusion will almost
surely keep you depressed, just as it keeps many of the ex-
So in the frst part of this book I’ll lay out the evidence
that implicates your lifestyle as the deciding factor. If I make
my case, and you become convinced, you’ll have the key to
ending your depression.
Your physical health is at stake, too
You may have read that depression is linked to other health
and safety problems, including anxiety disorder,
slow recovery from
and sudden death from natural causes.
between depression and these affictions isn’t surprising, be-
cause what makes you susceptible to them is the same set of
lifestyle mistakes that set you up for depression. Research
shows, again and again, that your lifestyle is the most impor-
tant factor in your physical health
So if you
start living a little differently in order to end your depression,
you’ll wind up in better shape generally, and with a dramati-
cally increased—we’re talking years
—life expectancy. And
believe me, when you stop being depressed, you’ll want to
live a long, long time.
¡ ¡ ¡ E S T Y ¡ E C H A N G E S C U R E ¡ T ¤
Five things that wreck your buoyancy
What is it about your lifestyle that’s depressing you?
To answer, let me begin by speculating a little bit about
you. If you suffer from major depression, my guess is that at
least three of the following statements apply to you. Probably
four of them do. The odds are pretty good that all fve of them
do. Let’s see if I’m right...
You don’t exercise much.
You stay up watching television, surfng the Web,
playing video games, reading, or working, and av-
erage fewer than eight hours of sleep even during
periods when you aren’t depressed.
You live on a diet that leans toward some combina-
tion of the following: meat and other animal prod-
ucts, packaged convenience foods, snacks, sweets,
and fast food.
Except at the job (if you work outside the home),
you don’t involve yourself much with people out-
side the house.
You’re addicted to something.
How did I do?
If I was right, it was no great feat, because the fve life-
style mistakes I’m talking about are now widespread in the
U.S., not only among people who get depressed, but across
the population as a whole.
Scant exercise, meager sleep, nu-
tritional recklessness, social isolation, and serious addiction
have come to be as American as Mrs. Smith’s Frozen Apple
Pie. The U.S. leads the world in these trends.
It’s why we
surpass all nations in depression,
as well other lifestyle dis-
UP W ¡ T H O U T ME D S q
orders such as obesity,
The same lifestyle trends are also dragging us down in
the World Happiness Survey, where we’re currently forty-
ffth in the rankings.
They’re even stunting our growth. Americans are now the
shortest people in the developed world.
How come? Accord-
ing to auxologists who study growth statistics and their im-
plications, relatively low average height in a population is an
indication of substandard living conditions.
In this coun-
try, those negative conditions are often ones that we choose
If it’s not one thing, it’s another
For people like you and me who start out with relatively weak
defenses against depression thanks to genes and childhood
conditioning, just living like a “normal” American is all it
takes to foster a severe mood disorder. For those whose buoy-
ancy is constitutionally more robust than yours and mine
and who choose the same damaging lifestyle that depresses
us, depression frequently is not in the cards, but a heart at-
tack, stroke, or other physical calamity often is.
Often, it’s not just one health problem that arises, either.
It can be a chain of adversities.
If you get depressed, it may
mean that something else is on the way. Studies show that
depressives fall prey to a wide range of illnesses at a much
higher rate than the population as a whole.
In this sense,
depression can be a warning of worse things to come, a ca-
nary in the coal mine.
¡ ¡ ¡ E S T Y ¡ E C H A N G E S C U R E ¡ T =
Explaining an epidemic
In Chapter 3 I cite statistics showing that depression in the
U.S. has been doubling in every generation since the Second
World War, and I ask why this has been happening. I argue
that the usual suspects blamed for depression—genes, child-
hood trauma, stress, and brain chemistry—don’t provide an
adequate explanation for the epidemic. But these facts do:
We’ve become the most sedentary human popula-
tion that ever lived.
We sleep two hours less than people used to.
We eat twenty-seven times as much sugar.
We’ve radically reduced invigorating human con-
tact, replacing it with enervating electronic con-
We’re addicted to dozens more substances and ac-
tivities than were even available just a few years
These fve regressive trends undermine health so predict-
ably, studies show any one of them increases the odds of seri-
ous illness, including depression, by a high percentage.
when you subject yourself to two or more of them, as most
Americans do, it can be devastating.
The limits of adaptation
Human physiology is a miracle of fexibility, but it has its lim-
UP W ¡ T H O U T ME D S 6
Your body has a wide tolerance for variations in activity
and passivity, but isn’t able to maintain itself properly when
you’re sitting down almost all the time.
You can continue to function at some level when you skimp
on sleep for several nights, but if you keep it up over a long
period, you cheat your body of important maintenance and
repair functions that occur while you’re sleeping, and things
start to fall apart.
Your metabolism can improvise brilliantly to deal with
more sucrose than any human encountered for millions of
years, but when you consume nearly a pound of it each week,
as the average American does,
the system heads toward
Although your body has no problem with periods of soli-
tude, a certain amount of meaningful social contact is a basic
Yet the average American is now so socially
disconnected, the effect on health is as harmful, researchers
say, as smoking two packs of cigarettes a day.
Your physiology can safely process impressive amounts of
alcohol, harsh drugs, and the jolting highs induced by gam-
bling and other compulsions, but a steady diet of any addic-
tive substance is more than most bodies can tolerate without
When you force your body beyond its limits, as most
Americans do, you commit a crime against yourself. In fact,
each of the fve conditions we’re talking about—exercise de-
privation, sleep deprivation, harmful diet, social isolation,
and doses of mind-altering substances—are defned as tor-
ture under the Geneva Conventions.
If you live like most
Americans do, you are literally torturing yourself.
¡ ¡ ¡ E S T Y ¡ E C H A N G E S C U R E ¡ T ;
Why do we keep doing it?
Is there something wrong with us modern folks? Have we
all become masochists? No. Basically, people are the same
as they’ve always been. We’re just standard-model human
beings who suddenly fnd ourselves living in a nonstandard
set of circumstances that are out of synch with our basic re-
During the last sixty years, life in the U.S. has changed so
rapidly that our bodies’ natural mechanisms which evolved
over centuries to keep us safe and healthy haven’t been able
to adapt fast enough. We’re equipped with an unimaginably
vast complex of homeostatic systems inside us that keep our
physiology balanced by adjusting to changing conditions. But
each system works only within certain limits. For example, if
the outside temperature shoots up to 100 degrees, you’ll start
sweating, and your body will make additional adjustments as
well, all to insure that your internal temperature stays at 98.6
degrees, or whatever your normal temperature is. But the
range this system can handle is narrow. Your internal tem-
perature regulator can’t protect you for any length of time
from an outside temperature of, say, 200 degrees. Humans
haven’t evolved to deal with that much heat, because we’ve
never had to; there are no 200-degree days on this planet.
If the earth were to move closer to the sun so that you could
bake a cake on the sidewalk, animals might eventually evolve
that could tolerate it, but it would take eons of mutation and
selection. The internal thermostat that you and I were born
with would be obsolete, and we would be, too.
UP W ¡ T H O U T ME D S 8
Evolution is way behind
Just as the body’s thermostat evolved in response to a certain
narrow range of temperature variation, our system for mood
regulation is based on a set of conditions that held steady for
millions of years, up until about the middle of the twentieth
century. These conditions included plenty of physical activity,
nine or ten hours of sleep, relatively unmodifed food, lots of
human contact, and much less addiction. But, starting with
the Industrial Revolution and then really taking off starting
a new world materialized under our feet. Soon,
from the standpoint of mood regulation and many other hu-
man physiological balancing systems, the accustomed world,
the one we were adapted to, was gone, and we found our-
selves walking around in 200-degree heat.
Unintended consequences of progress
No one is to blame for the fact that humans are suddenly liv-
ing in a world for which we weren’t made. It’s just something
that developed naturally. No one planned or anticipated it.
But there’s no question what created it:
Technology has supplanted our bodies for most physi-
cal tasks, depriving us of exercise. It provides new forms of
entertainment that encourage passivity, social isolation, and
sleep deprivation. It creates foods to which we become ad-
dicted. With the automobile, it gives birth to suburbs, where
few individuals are able to maintain their connection to a
community. It concocts a witch’s brew of recreational and
therapeutic drugs that dangerously alter body chemistry.
Commercialization and consumerism. In our cul-
ture, the primacy of money and what it can buy means that
human physical needs take a back seat to the desire for keep-
ing factories operating twenty-four hours, stores open seven
¡ ¡ ¡ E S T Y ¡ E C H A N G E S C U R E ¡ T ¤
days, and shelves stocked with products that harm people but
keep being produced anyway because they generate profts.
Since time is money, a “right-thinking” American maxi-
mizes wealth by avoiding exertion that doesn’t pay, by sleep-
ing parsimoniously, by minimizing time spent preparing and
eating food, and by largely avoiding contact with anyone out-
side the family who isn’t part of the organization where he
Wealth. Never before in human history has the average
citizen had the wherewithal to hire others to do most of his
physical work for him, to purchase diversions that keep him
up late, to delegate the production of his meals to food-prep-
aration mercenaries, to isolate himself in a cocoon of elec-
tronic devices, or to buy an unending supply of experience-
enhancing substances from every continent. In this country,
everyone, including teenagers, has the wealth to purchase
health-wrecking chemicals that, until just a few decades ago,
couldn’t even be bought by emperors.
Not all of these developments are bad, by any means.
But they’re new, so new that both human culture and hu-
man physiology haven’t had time to adapt to them. What is
bad, though, are some of the effects of all the newness. These
include escalating rates of obesity, diabetes, heart disease,
cancer, Parkinson’s disease, Alzheimer’s disease, and frail-
ty. Last and certainly not least, they include the astonishing
boom in depression rates since the Second World War. Most
of us would agree that we are the lucky benefciaries, in so
many ways, of modern progress. But it’s also clear that when
you get depressed, you are its victim as well.
UP W ¡ T H O U T ME D S 1o
Defending against modernity’s downside
In many areas of your life, you’ve developed strategies for
enjoying the fruits of progress without being harmed by it.
For example, if you’re a typical parent, you’re grateful for the
educational and entertainment opportunities the Internet
provides for your children, but you know that you have to
be vigilant about protecting them from the wrong sites. You
take advantage of the almost limitless array of food choices
at a modern supermarket, but you understand you have to be
more discriminating than people had to be back in the days
when options were few. You may be grateful for all the medi-
cal advances that have come along during your lifetime, but
know you have to watch out for dangerous drugs and unprov-
en treatment fads that have ridden in on the same wave.
In the same way, you need to play good defense against
regressive lifestyle changes that progress has brought. If you
are able to do that, your depression will end—in spite of your
genes, your childhood, your stress level, whatever chemical
imbalance you think you have, and any other problems that
life has handed you.
Common solutions that don’t address the real problem
Instead of protecting yourself from the unintended conse-
quences of progress, perhaps you’re trying to alleviate your
symptoms with antidepressants or talk therapy. That’s fne,
but neither drugs nor talk, nor both together, address the
negative effects of modern living that are the root cause of
your depression. That’s why these treatments can sometimes
mitigate symptoms, but can’t offer a cure.
¡ ¡ ¡ E S T Y ¡ E C H A N G E S C U R E ¡ T 11
A supporting role for meds
If you’re currently taking antidepressants and you feel they’re
helping, by all means stay on them. They won’t interfere with
the recommendations I’m going to make, and may give you
a base of confdence from which to work. In Chapter 4, I’ll
discuss how drugs help some people feel better primarily by
improving their psychology through the placebo effect. This
kind of help, if you’re one of the lucky people who fnd it in
pills, can be signifcant, though costly in more ways than one,
as I explain in the same chapter.
Don’t fre your therapist
If you’re in psychotherapy and you feel it’s useful, stick with it.
In addition to any positive shifts in consciousness that might
take place, talking with an empathetic professional can pro-
vide enlivening social contact, an important factor in condi-
tioning you against depression. Your therapist can also give
you strong support for making the fve lifestyle decisions I’m
going to recommend. Every psychotherapist I’ve discussed it
with embraces the idea of building emotional buoyancy by
correcting lifestyle mistakes, and is enthusiastic about work-
ing with clients who want to do it. A good therapist who un-
derstands your goals can be a great person to have in your
Doctors and psychotherapists frequently don’t push the
lifestyle changes that I recommend, but this isn’t because
they’re completely unaware of the benefts. When primary
care physicians in England were asked what treatment they
would choose for their depressed patients, most named medi-
cation. When these same doctors were asked how they would
deal with their own depression, many said they’d skip the
pills and exercise instead.
They believed exercise would be
UP W ¡ T H O U T ME D S 1z
better and were willing to do it themselves, but didn’t trust
their patients to do it. But you and I can prove they underes-
Live, personal guidance and support
Most people fnd they make changes more reliably when they
don’t have to depend on themselves exclusively for motiva-
tion, but have someone in their corner cheering them on.
This person can be a therapist, life coach, friend, or family
member—anyone who’s committed to you and your goals and
has the strength and skills to support you. You can also sign
up for live, personal guidance and support at my website:
If you’re suicidal
If suicide is a possibility for you, you shouldn’t be reading
this book, or any book. Put it down now and call 911 or get in
touch with a physician. The person who answers the emer-
gency call or the doctor can get you into a hospital, where
you’ll be in the hands of professionals who are trained in sui-
Other varieties of depression
If you suffer from a type of depression that’s different from
the one addressed in this book, I’m confdent that making
some lifestyle changes will help you, but since I don’t focus
on these disorders, I can’t guarantee results. My approach
is intended for the condition known as clinical depression,
major depressive disorder, or unipolar disorder. This type of
depression is characterized by a recurring cycle that includes
¡ ¡ ¡ E S T Y ¡ E C H A N G E S C U R E ¡ T 1¤
periods of normal mood interrupted by days or weeks of dis-
abling low mood. Other types of depression, which may or
may not respond to the approach, are bipolar disorder (man-
ic depression), post-partum depression, depression resulting
from Post Traumatic Stress Syndrome (PTSS), seasonal af-
fective disorder (SAD), and dysthymia, a non-disabling, per-
manent low mood.
Dealing with someone else’s depression
If you’re not someone who gets depressed but you want to help
someone who does, this book, in my opinion, is the one for
you. That’s because, of all the approaches for treating depres-
sion, this one offers you the best opportunity to lend a hand,
by supporting the person you love in making the changes
that will end her depression. As I discuss in Chapter 11, social
support is so important to this approach that most people
shouldn’t expect to succeed without it. But keep in mind that
the person you’re helping has to be fully committed herself
in order for it to work. It’s like any personal change. Your en-
couragement and support are enormously valuable, but you
can’t do it for them.
Because lifestyle changes address the real causes of de-
pression, they will work for you like nothing ever has. I don’t
care who you are, how bad your genes are, how tragic your
childhood was, how stressful your life is, how many episodes
you’ve had, or how severe those episodes were. If you fully
embrace this approach, you will recover.
Here are some other things I think you’ll like about the
lifestyle approach, especially when compared with drugs:
It costs nothing. »
UP W ¡ T H O U T ME D S 1q
It requires no appointments, no trip to an offce full
of sick people, no half hour or more spent reading
two-year-old magazines, and no haggling with an
Instead of unpleasant and possibly dangerous side
effects, it produces side benefts that improve every
aspect of your life.
It doesn’t addict you to anything.
It starts giving you some protection against depres-
sion right away.
It allows you to increase the “dosage” when you feel
depression coming on so you’re able to pull out of
It puts control in your hands rather than someone
It preserves your privacy, and so avoids possible
embarrassment, career damage, and future health
It can be effectively and safely combined with any
other depression treatment, including drugs and
It’s safe for children and teenagers, pregnant and
new mothers, people on medications, and older
people. In fact, it’s more than safe, since it improves
your health, no matter what your age or condition.
In the next chapter, I’ll tell you how I wound up discovering,
almost inadvertently, the way out of depression.
T W O
ho W my De P r e s s i o n e n D e D
I h a d r e s i g n e d my s e l f t o b e i n g
d e p r e s s e d f o r t h e r e s t o f my l i f e .
T h e n c a me t h e u n e x p e c t e d .
even years ago I lost my business, my income, my
house, most of my savings, my health insurance, and
my SUV. This is what led to the end of my depression.
I don’t recommend this particular way of going about it,
but if I tell you the story, I think you’ll begin to see the pos-
sibility of ending your own depression, but without the tur-
moil that preceded my recovery.
I suffered my frst episode of major depression when I
was 16, the year I gave up high school sports. Subsequent ep-
isodes came on a fairly regular basis, and in my sophomore
year at Harvard I became so depressed that I had to drop
out. Later, I went back and fnished. I got married, started
a family, and began a career in advertising. My life looked
fairly normal, except for one thing: Four times a year on av-
erage, I came down with depression so severe, I had to call
in sick and stay in bed. This pattern lasted for a total of forty-
fve years in spite of three courses of psychotherapy and a
fing with Prozac.
By the time I reached middle age, I had abandoned any
hope of ever recovering. After struggling with depression for
so many years and never making any headway against it, I
came to see myself as someone born with an inoperable de-
fect. But I was wrong.
UP W ¡ T H O U T ME D S 16
Beating the system
In 1989 my wife Judy and I moved to the mountain-resort
town of Taos, New Mexico. Trading our advertising hats (we
had met at the agency we both worked for) for storekeeper
aprons, we opened a chain of small shops catering to tourists
in Taos and in other tourist destinations in the Rockies. Our
timing, just a lucky accident, was perfect, and most of our
stores took off. Within a few years, we were fnancially even
more comfortable than we had been back in the Boston area.
In fact, we were the only people I knew who had defed the
Taos Economic Fact of Life, expressed by a joke frequently
Q: How do you wind up with a million bucks in Taos?
A: Move here from Texas with two million bucks.
Financially, we did quite well after we arrived, and had the
possessions to show for it, including a house that a celebrat-
ed artist pronounced the most beautiful in Taos County. The
owner of our local wine store said she had only one customer
who spent more money on fne vintages than I did. When
my prosperous poker buddies from Boston invited me to join
them on annual vacations at extravagantly expensive resorts,
I didn’t hesitate.
Easy come, easy go
However, tourist travel and spending patterns soon started
to change, and most of the changes went against us. Having
succeeded mainly by stumbling into the right place at the
right time, I didn’t know what to do when I found myself in
the wrong place at the wrong time. Sales in all of our stores
began slipping. As things went from bad to worse, my inabil-
ity to adjust to the new trends almost—but not quite—ruined
us fnancially. By the end of 2001, all of our stores were ei-
HO W MY D E P R E S S ¡ O N E N D E D 1;
ther closed or owned by someone else.
We moved out of our showcase house into a tiny condo.
We traded our majestic gas-guzzlers for two worn compacts.
I retreated from my ten-thousand-square-foot corporate
headquarters to a table in the garage. I became an eBay re-
tailer—and not a particularly successful one.
In the end, Judy and I bowed to the Taos Economic Fact
of Life. We had arrived in town as near-millionaires from
Boston, and wound up as Taos thousandaires.
A life turned on its head
As an entrepreneur with big growth plans, I had been con-
sumed with the business, and always had more money than
time. I had spent almost every available hour on three pur-
suits: making money, spending it, and escaping the pain of
my high-pressure life, mostly through alcohol. Now sudden-
ly, as a self-employed stock boy and shipping clerk (which is
mostly what a small eBay seller is), I was earning about ten
dollars an hour and too bored to work overtime. Now I had
more time than money.
What do you do to stay busy when you have time on your
hands and your wealth has evaporated? One possibility is
self-improvement, an affordable way to occupy the hours,
and one that can be appealing to someone whose business
disappointments have made him feel as if he could stand
some improvement. Someone who is seriously underem-
ployed, as I was now, also has the extra energy and drive
available to take on something new.
I recognized that years of stress, depression, and physi-
cal inactivity had increased my chances for heart trouble and
other diseases, so I began exercising every day, starting with
a pleasant forty-minute walk through the tourist area that
my stores had once dominated, and then through a pretty
park. After a few weeks of this, I was surprised to fnd that I
UP W ¡ T H O U T ME D S 18
was starting to feel more buoyant.
During this period, I also started to take an interest in
spiritual matters, another consequence of living a more re-
laxed life. I decided to try a nearby church. I found the warm,
meaningful conversations that people were having there re-
ally lifted my spirits.
I discovered that without knowing it, I had joined what
is surely the most socially active religious organization in
town. On an average Sunday, thirty or forty members would
get together for the service, but that was just the tip of the
iceberg. There were potlucks, birthday parties, dances, lec-
tures, study groups, discussion circles, service committees,
exercise classes, and workshops, and these “peripheral” ac-
tivities attracted, in aggregate, ten times as many people as
Sunday services did. There was so much going on, a few de-
clared atheists had decided their ontological views needn’t
stand in the way of a good time, and I sometimes ran into
one or two of them there.
Soon I was organizing groups of my own at the church,
including a hiking group. I was now more involved with
people than I ever had been during the years when I ran my
company, and now the relationships were based not on cold
commercial motives but on mutual interests and passions,
and on warm human connections. There was love in these
social transactions. I started to notice that I wasn’t getting
depressed as often, or as deeply.
As my life became more user-friendly, I started to expe-
rience an unaccustomed lightness. However, I also noticed
that this pleasant state disappeared after meals, when I
usually felt heavy and lethargic. The writer Michael Pollan
hadn’t yet published his famous seven words of advice—“eat
food [as opposed to industrially-processed food products],
mostly plants, not too much”
—but my intuition was whis-
pering similar notions in my ear. Judy was having some of
the same ideas. So we started experimenting.
HO W MY D E P R E S S ¡ O N E N D E D 1¤
I’m the cook at our house, so it was up to me to pioneer
our forays into the world of locally-grown vegetables, sea-
sonal fruits, fresh herb favorings, whole grains, marinated
steelhead trout, old-fashioned oatmeal, and blue agave nec-
tar. Except on rare occasions, we stopped consuming red
meat, most commercial bakery products, sweetened des-
serts, soft drinks, processed sugar, convenience foods, and
What–healthy food isn’t for ascetics?
What happened surprised us.
To begin with, we found we didn’t suffer. Eating “food,
mostly plants, not too much”—didn’t force us, as I had
feared, to trade pleasure for virtue. The new stuff actually
tasted better! This really shouldn’t have surprised us, be-
cause, just as the best rose scent is not to be found in air
freshener or hybrid fowers engineered to travel, but in your
grandmother’s relatively unmanipulated heirloom varieties,
the best favors are the province of old-fashioned, unadul-
terated, home-cooked ingredients, and especially plants,
which, after all, are responsible for most of the taste in the
best meat dishes. The Italians have always known this. Alice
Waters, the patron saint of California cooking, has been say-
ing it for years: The foods that are bad for you don’t taste
particularly good, and the foods that are good for you, if you
prepare them correctly, are what human taste buds are look-
ing for after eons of adaptation to—what else?—eating most-
ly plants. The foods that are good for you are the foods you
were born to eat.
Cooking more healthful, better tasting meals doesn’t re-
quire much additional time, either, no matter what the com-
mercials for prefab meals imply. A recent survey found that
people who cook from scratch spend only a few minutes
more than people who open a box.
You just have to be a de-
UP W ¡ T H O U T ME D S zo
cent meal planner, and that’s something anybody can learn
The accidental diet
Eating real food, mostly plants, I ate as much as I wanted,
and Judy never went hungry, either. Even though we had
no particular weight loss goals, both of us dropped pounds
slowly but steadily over the course of several months, until
each of us reached what our bodies seemed to consider our
natural weight, and some internal homeostatic mechanism
halted the process. When I stopped losing, I tipped the scales
at 142, thirty-three pounds lighter than my heaviest, and
exactly what I weighed as a high school senior almost ffty
years ago. (I’m just 5’-7”, and a classic ectomorph, so this is
the right weight for me.)
Seeing the silhouette of my 17-year-old self when I looked
in the mirror was nice, but more important to me was know-
ing that in giving up nutritional recklessness and backing
away from obesity, I had reversed my odds for heart disease,
stroke, and diabetes, and had extended my estimated life
expectancy by many years. My blood pressure, nothing spe-
cial before, had fallen into the Tibetan-monk range, at the
very low end of normal. And my cholesterol had dropped 80
points since my previous screening.
On top of all the good news that my doctor had for me,
eating right led to a result that no one needed to tell me about,
because I experienced it for myself every day: My new diet
stabilized my mood. Emotional buoyancy became my norm.
So long, Happy Hour
For me, the last frontier was alcohol, something I had never
planned to give up. Several years earlier, having drinks with
my poker buddies, I had acknowledged for the frst time that
HO W MY D E P R E S S ¡ O N E N D E D z1
I was an alcoholic. When my pals, some of whom had already
guessed there was a problem, began urging me to quit or cut
back, I interrupted them, saying, “No, you don’t understand.
I don’t want to change. I’m only telling you this to be honest
with you, not so you’ll help me stop.” And I continued drink-
But now I felt differently. I still didn’t believe it was par-
ticularly important to quit—I was what they call a high-func-
tioning alcoholic, not a falling-down drunk—but I had been
reading Eckhart Tolle’s book, The Power of Now, in which
he talks about fnding happiness in the present, and it struck
me that I was not someone who often found happiness in
the present, unless the present happened to be after 6 p.m.,
when I had my frst drink. I realized that every day for many
years I had waited all day, postponing life until the happi-
ness fairy, fying on Chardonnay wings, put some joy under
my pillow. Now, with improved energy and reliable buoyan-
cy, I realized Happy Hour could be any hour of the day, and
the happiness fairy be damned. I decided to try sobriety.
On the wagon and riding comfortably
If I was surprised to fnd that turning away from lousy food
was no sacrifce, I was shocked to discover that alcohol was
now of no great interest to me. The desire for it had just fall-
en away, like a dead leaf dropping off an oak in autumn. The
earlier changes I had adopted—regular exercise, meaning-
ful social contact, dietary soundness—had brought me to the
point where I was no longer living under physical and emo-
tional clouds. Why would someone who already feels fne be
compelled to have a drink? What’s more, without the ups
and downs of the alcohol ride—think of the alcoholic who
alternately rages and coos—I found that my disposition be-
came milder, and my overall sense of wellbeing increased
noticeably. After a couple of weeks on the wagon, I felt so
UP W ¡ T H O U T ME D S zz
much better that I knew I would never drink again. And I
began to see the possibility that I would never be depressed
In Chapter 12 I tell the conclusion of this story—how,
after conditioning myself against depression by making the
changes I’ve been describing, I discovered how to pull myself
out of the rare episode that could still threaten my new buoy-
ancy. This discovery meant that I now had an emergency an-
tidote that would reverse any downward spiral. Now, nothing
could ever keep me down again. I had become unsinkable.
Knowing that after forty-fve years of suffering, depres-
sion was out of my life for good, I mounted a little black-
board on the pantry door to advertise my good fortune:
The blackboard, updated every day, is now online, at:
Check it out and see how I’m doing.
In Chapter 7 I discuss adequate sleep as one of the fve
essential lifestyle commitments that end depression. This is
the one precept that isn’t based on my personal experience,
because, unlike most of my fellow depressives, I’ve always
been a virtuoso, world-class sleeper, clocking eight or nine
HO W MY D E P R E S S ¡ O N E N D E D z¤
hours every night. But, while sleep deprivation didn’t play a
role in my depression, it’s a key factor in the majority of cas-
es, according to studies that have examined the link.
talk more about this later.
Blindsided by success
Several things are noteworthy, I think, about my story. The
frst is that as I made changes to my lifestyle, I wasn’t think-
ing about ending my depression. I didn’t even know this was
possible, until it happened more or less spontaneously. I just
knew, as a matter of general knowledge, that the changes I
was making were considered to be salutary, and, especially
at my age, it made sense to start taking better care of myself
by incorporating better habits into my life.
Everyone knows it’s good to exercise. No one denies you
should get out and about. Every mother tells you to eat your
vegetables. No one recommends alcoholism as a way of life.
We’re talking here about well-worn, perfectly conventional
ideas memorialized in countless bromides. What I didn’t re-
alize until I had adopted them was that regular exercise and
the rest aren’t just fller content for free pamphlets put out
by government agencies. They were—or rather, my disregard
of them was—the very cause of my depression. But I didn’t
know that until I made the changes.
The man without a plan
The second thing to note is that I was not following a pro-
gram or conscious plan. If anybody had ever come to me and
said, “Starting tomorrow, you’re going to exercise every day,
clean up your diet, spend more time in good conversations,
and, oh, while you’re at it, give up drinking”—I would have
shown them the door. Unless somebody held a gun to my
head, and I mean literally held a gun to my head, I would not
have been able to tackle all of these changes simultaneously.
UP W ¡ T H O U T ME D S zq
Build Rome in a day? Conceivably. But not this.
Fortunately, there was no need to bite it all off at once.
Since I wasn’t following a plan and didn’t know where I was
going, I never thought ahead. I started off by taking just one
step in the right direction, and that single step eventually led
to another one. The frst step made me stronger and gave me
the impetus to go further. Regular exercise provided more
energy and a brighter outlook, so eventually I felt like be-
coming more involved with other people. Increased social
contact expanded me to the point where changing my diet
began to seem like an interesting experiment rather than a
source of tribulation. Each change seemed relatively easy,
because I didn’t even think about attempting it until I was
ready. Eventually, without planning it, I found that my nor-
mal experience of life was so satisfactory that alcohol had be-
come superfuous, and I gave it up without a struggle. Every-
thing happened gradually, with one thing leading to another.
Nothing happened before I was ready. Nothing was forced.
The whole process took about eighteen months.
Up without meds
Notice that antidepressants, psychotherapy, supplements,
affrmations, and other common methods for reengineering
someone’s mood don’t play a part in my story. Since I had
tried each of these unsuccessfully, I never considered them
during this period. However, I’m certain that if I had been
using any of them, my depression would have ended just as
surely, provided I wasn’t relying on them as a substitute for
lifestyle changes. Without these changes, no matter what
else I was doing, I would never have recovered completely,
because it was my lifestyle that was the deciding factor in my
HO W MY D E P R E S S ¡ O N E N D E D z=
Was it just a fuke?
After my depression ended, I became curious about whether
there was any scientifc evidence to explain my recovery. I
found there was plenty. In recent decades, and especially
during the last ten years, people at the Mayo Clinic, Har-
vard, Yale, Brown, the University of California, the Univer-
sity of Chicago, the University of Texas, and dozens of other
research centers had been gathering data that would lead
anyone, if they were paying attention, to the lifestyle expla-
nation for depression. I share this information with you in
White coats cause tunnel vision
There is no study I know of that will tell you specifcally that
there are fve lifestyle decisions that end depression. But
that’s exactly what all the data add up to collectively. A group
at the University of Texas helped establish a connection be-
tween mood and exercise.
At Harvard, they found a link be-
tween mood and diet.
At the University of Chicago, it was
mood and social isolation.
And so on. Each research group
had a piece of the depression puzzle, but wasn’t looking at
any of the other pieces that, all put together, would show
the whole picture. Each group was obligated to focus on a
single narrow issue, because it isn’t possible to do science in
broad strokes. Instead of seeing the forest, a researcher has
to closely examine just one tree. It’s up to us generalists, the
ones not wearing white coats, to take a step back, survey all
the trees the scientifc specialists have spotted, and see the
forest there. That’s what Michael Pollan did, when he boiled
down hundreds of nutrition studies into his famous seven
words: “Eat food. Not too much. Mostly plants.”
Another limitation on scientists is that they have to turn
a blind eye to many manifest truths, because the scientifc
method forces them to be almost comically conservative in
UP W ¡ T H O U T ME D S z6
drawing conclusions. They must limit their claims to cir-
cumspect statements like: “Low folic acid is a correlate of
depressive symptoms in community-dwelling middle-aged
individuals.” But we generalists don’t have to confne our-
selves within these artifcial limits.
One more reason you haven’t read much about the lifestyle
approach is that the evidence for it, though publicly accessi-
ble, is usually drowned out by the billions of dollars in drug-
company advertising that promotes a persistent chemical
imbalance as the root cause of depression.
Some of this ad-
vertising is directed at consumers, but the target for most of
it is physicians, and the money is well spent. Your doctor’s
most valuable asset is his time, and he’s receptive to any
theory that makes it acceptable for him to dispose of a case
quickly by speed-writing a prescription and moving on to the
next patient. Once he buys into the drug companies’ slant
on things, it’s all downhill from there. The doctor’s quasi-
religious authority means that, just on his say-so, dozens of
his patients become believers. Multiply all those patients by
almost a million doctors in the U.S., and you’ve got one of
the strongest misinformation networks known to history.
No wonder it’s virtually impossible for me to have a conver-
sation about depression without the person across from me
saying, usually within the frst two minutes, that they believe
depression is caused by a chemical imbalance.
What doctors know is what drug companies tell them
Your doctor isn’t a researcher. For the most part, all he
knows, beyond what he learned in medical school and the
continuing education seminars for doctors often paid for by
drug companies, is what he reads in the medical journals,
and he tends not to make a clear distinction between the edi-
HO W MY D E P R E S S ¡ O N E N D E D z;
torial matter and the ads. He doesn’t have the time and may
not even have the analytical skills to look at the raw data re-
ported by the studies and draw sound conclusions. Even if
he’s the rare doc who looks more deeply into things to form
his own ideas, there’s always a drug-company rep, usually
an attractive woman known in the trade as a “pharma babe,”
at the doctor’s door every day offering him and his staff free
lunch if he’ll agree to listen to her pitch.
More often than
not, he accepts the offer.
The media are also complicit. For their editorial content,
medical journals depend on depression studies sponsored
by the drug companies and on “independent” studies that
are usually led by researchers in the pay of and barely an
arm’s length away from those same drug companies.
The consumer media push Big Pharma’s message as
well, and not just because drug companies are important
consumer advertisers. A news outlet sells its product by tell-
ing compelling stories, and the people who make editorial
decisions are astute judges of what does and does not grab
people. They know no one is interested in reading the same
dull advice you’d get in a government publication—exercise,
get plenty of rest, eat right, and blah blah blah. But a tech-
nological advance, a magic bullet, a little pill that promises
to eliminate one of the scourges of modern life? Now that’s a
story—even if it doesn’t contain much truth.
Slandering the real cure
The drug companies and media have managed to subtly
undermine lifestyle methods that are demonstrably more
effective than pills, by pinning the phrase “alternative ap-
proaches” on them. Go to any website that’s sponsored or
infuenced by a pharmaceutical company, and you’ll learn
that these alternative approaches may help in cases of mild
depression or may be helpful as a supplement to drug treat-
UP W ¡ T H O U T ME D S z8
ment or psychotherapy.
The language makes it clear that
if you start exercising instead of taking a pill, you’re using a
slingshot instead of a cannon.
“Alternative approach” is a piece of absolutely brilliant
slander. What do you think of when something is labeled
an alternative approach? Here are some of the associations
that come to mind when I run across the term:
A spiritual healer practicing in a jungle, where you
go in desperation when told that your cancer is
An herbal remedy based on folklore or hearsay
that hasn’t been validated by scientifc research
Any approach based on an alternative reality and
not endorsed by Western medicine
An alternative approach is one that’s untested, unproven,
unreliable, and possibly unsavory. It’s a pipedream out
of left feld that’s hardly worth considering unless you’re
either kooky or desperate.
Yet one of these “alternatives”—a package of lifestyle
changes—is the one that offers real potency and actually is
validated by Western science. Because this approach ends
depression by removing its most important underlying
causes, it is not just a Hail-Mary pass to fing when the “real”
treatments don’t work. It is the real treatment. It’s what to
do frst, not last. It isn’t backed by a billion-dollar ad budget,
a brigade of pharma babes bringing lunch, or a nation of pre-
scription-writing docs. It doesn’t generate the buzz that sells
magazines. It isn’t the latest technological miracle. With all
this against it, no wonder it isn’t the frst thing people think
of when they think about recovering from depression. But it
HO W MY D E P R E S S ¡ O N E N D E D z¤
does have one thing in its favor: It works.
But will it work for you?
To answer this question for yourself, start by reading the
next chapter, which makes it pretty clear, I think, that the
most important underlying causes of your depression are
the same as, or at least quite similar to, mine. If you agree
that your depression and mine share the same causes, it’s a
small step to see that, like me, you can remove them, so your
depression no longer has anything to feed on. Because you
took approximately the same route to depression as I did,
you can take the same way out.
Believe it or not
The lifestyle approach doesn’t ask for a great deal of trust
from the people who try it. In contrast to the faith required
when you try antidepressants or psychotherapy, it isn’t nec-
essary to wait six, eight, ten, twelve weeks, or more before
fnding out whether it’s working.
You’ll feel your morale
lifting and your buoyancy increasing with every small step
you take. You’ll know you’re getting better as surely as you
know, when you eat, that you’re getting fuller.
But will you be able to make the changes and stick to
them? Absolutely you will—as long as you go at the right pace
and don’t get ahead of yourself. Take small steps, following
the guidance in Chapter 11.
For additional help, you’ll fnd options for live, personal
guidance and support at my website, 5decisions.com.
Let your confdence build. Give yourself time to let new
habits form, and to start feeling better as your body beco-
mes happier. As you gain strength with each step, it’ll make
the next step that much easier. One good thing will lead to
another naturally, without your having to force it. Then,
instead of being trapped in the vicious circle of depression,
you’ll have the positive momentum of a virtuous circle, as
UP W ¡ T H O U T ME D S ¤o
in: “the rich get richer.” Only in your case, it’ll be the healthy
get healthier and the lighthearted become more and more
T H R E E
th e th r e e un D e r L y i n g
C A u s e s o f De P r e s s i o n :
nA t u r e , nu r t u r e ,
A n D f u r n i t u r e
T h e d e c i d i n g f a c t o r i n y o u r
d e p r e s s i o n i s r e v e r s i b l e .
t took more than one bad break to turn you into a depres-
sion victim. To begin with, you had to get unlucky geneti-
cally. Then, you had to be scarred in particular ways dur-
ing childhood. But even though you were dealt both of these
setbacks, they weren’t, by themselves, enough cause clinical
depression. Something else had to happen to you.
I call it the Furniture Factor.
Before discussing it, let me ask: What do you think de-
Some people tell me that what gets them down is “the way
the world is today.” Others say it’s some negative situation
closer to home, like job or family problems. These answers
aren’t entirely off the mark, because depression often strikes
when someone is having a bad day or a bad year.
But it isn’t
plausible that external circumstances are the deciding factor
in your depression, and here’s why: We all live in the same
world with the same outrages taking place, and we all have
job and family problems, yet most of the individuals who face
these problems never become clinically depressed, as you do
and I did.
You may have a sense that it’s not what’s going on out-
side that’s the main problem. Perhaps you suspect that the
UP W ¡ T H O U T ME D S ¤z
negative thoughts you have about the world when you’re de-
pressed aren’t necessarily an accurate description of reality,
much less the cause of your depression, but more often an
effect of it. If so, you’re getting closer to the truth.
Big Pharma’s educational contribution
In the 1980s, the drug companies began aggressively pro-
moting a new class of antidepressants they had developed,
and they based their claims on the theory that depression
is caused by a persistent imbalance in brain chemistry. I’m
no fan of Big Pharma, but the companies have performed a
valuable service in steering people toward the entirely cor-
rect notion that depression is rooted in something other than
unhappy circumstances—that it isn’t a normal response to
life’s slings and arrows, but a pathology.
But what causes this sickness?
I like shipwreck metaphors for depression, so here’s one.
When you become depressed, what sinks you is the same
thing that sank the Titanic: a collapsed homeostatic system.
Homeostasis is a term coined by the American physiolo-
gist, Walter Cannon, in 1932. It refers to the natural tendency
of a system to return to its normal state, or set point, after it’s
You fnd homeostasis everywhere in nature. Without it,
no organism could live more than a few minutes. Homeo-
stasis is what keeps your body temperature at 98.6 degrees
Fahrenheit, or whatever is normal for you. It’s what main-
tains your blood sugar within a safe range, if you’re healthy.
It’s what keeps your heart beat regular.
When the Titanic embarked on April 10, 1912, no one had
heard of homeostasis yet, but the Titanic’s homeostatic sys-
tem is what the passengers were counting on. People said the
Titanic was “unsinkable.” What they meant was that no mat-
NA T U R E , NU R T U R E A N D ¡ U R N ¡ T U R E ¤¤
ter what kind of trouble the ship ran into, it would be able
to recover its normal state. The ship was unsinkable, they
thought, because its homeostasis was unassailable. The prin-
cipal homeostatic feature was a series of sixteen water-tight
compartments that were designed to maintain the ship’s
buoyancy come hell or high water (or iceberg).
Cold water and brittle steel
Unfortunately, the Titanic had a weakness that most people
didn’t know about: The hull was made of open-hearth steel
instead of the superior Bessemer-process steel. Open-hearth
steel is weaker than Bessemer steel to start with, but another
property of the metal may have been even more of a factor
that night: It starts to become brittle when exposed to tem-
peratures below 68 degrees, and the lower the temperature,
the more brittle it gets. The water temperature where the Ti-
tanic was sailing in the North Atlantic on April 14 was 31
When the Titanic hit the iceberg, its water-chilled, brit-
tle hull cracked like an egg, and a one-hundred-metre gash
opened up in six of the water-tight compartments, crippling
the Titanic’s homeostasis. Instead of balance being restored,
abnormalities started compounding. A vicious circle ensued,
driving the system farther and farther away from its nor-
mal state. As water displaced air in the water-tight compart-
ments, the ship grew heavier. With this increased weight, it
sank lower in the water. The lower it went, the more water it
took on. And the spiral continued until the ship was on the
When you’re depressed, you may feel as if you’re trapped
in a spiral, and that is precisely what is happening. Like the
Titanic, you’ve suffered a breach. Something has collapsed,
and the collapse has created a negative dynamic in which ev-
UP W ¡ T H O U T ME D S ¤q
erything inside you is going in the wrong direction, spiraling
in a vicious circle. But instead of water and weight, what’s in-
teracting dynamically in you are negative thoughts, negative
body chemistry, negative body sensations, negative behavior,
and negative circumstances, all amplifying and perpetuat-
ing each other, each increasing all the other variables, until
you’re on the bottom.
When homeostasis is operating normally, people don’t
stay way up or way down for long. Lottery winners are fa-
mous for soon dropping back to their pre-win happiness lev-
el, and someone who’s fred from her job usually gets over it
in fairly short order. This tendency for everything to return
to normal is why, when you’re down, people may say to you,
“Give it time. Time heals all things.” But it isn’t really time
that heals you. It’s homeostasis.
When the passing of time doesn’t seem to make a differ-
ence, when you don’t bounce back after a loss or disappoint-
ment but just keep sinking, that’s clinical depression.
homeostatic system that you depend on to bring you back to
the surface has collapsed.
But why does homeostasis fail more easily in you than in
Playing the slots for genes
Chances are, you’re genetically predisposed to depression.
They’ve even identifed one of the culprits: the 5-HTT gene.
It comes in two variations, long (good) and short (bad). Since
you have two sets of chromosomes, you carry two copies of
the 5-HTT. This means that when you were conceived, you
had two chances to get lucky or unlucky.
About a third of all babies born hit the jackpot. Both genes
come up winners, providing these individuals with maxi-
mum protection. Very few of them ever suffer from clinical
NA T U R E , NU R T U R E A N D ¡ U R N ¡ T U R E ¤=
depression as adults, no matter what life hands them. They
may get blue, and may even say they’re depressed. But they
recover on a normal schedule.
Another 50 percent break even. That is, they have one
long gene and one short one. This means potentially less
buoyancy for them than the frst group, but enough to keep
the vast majority from ever getting severely depressed.
The third group, comprising about 17 percent of the popu-
lation, is where you’ll fnd most victims of major depression,
including yourself, in all probability.
When you pulled the
handle on the slot machine, two short genes came up.
But two short genes by themselves still aren’t enough to
cause your depression. Statistical studies show that major
depression is only one-third heritable.
This means that your
genetic inheritence, as bad as it may be, still gives you favor-
able, 2-to-1 odds that you’ll get through life without a single
But then, I’m guessing, you had some rough times when
you were growing up, and the odds changed.
The childhood factor in depression was highlighted by a
study conducted by Terrie Mofftt of the University of Wis-
consin and Avshalom Caspi, reported in the July 18, 2003,
issue of the journal Science.
The study confrmed that the
“double-negative” form of the 5-HTT gene is a marker for de-
pression, but it went on to show that the gene tends to be
damaging only to people who grew up under problematic
conditions. Since you get depressed, it means that you prob-
ably got clobbered twice—frst by your genes and then by
negative conditioning in your early years.
Yet statistics argue that both of these preconditions still
aren’t enough to sink you.
In order for you to become clini-
cally depressed, there needs to be yet a third blow to homeo-
UP W ¡ T H O U T ME D S ¤6
stasis. It’s what I call the Furniture Factor, and here is the
furniture that’s involved:
The couch you sit on instead of exercising
The bed you don’t spend enough time sleeping in
The television or computer screen you park your-
self in front of instead of getting out of the house
and enjoying other people
The dinner table where you eat—and probably
overeat—for comfort and convenience rather than
The bar, coffee table, fast-food booth, computer
chair, or casino table where you indulge an addic-
The deciding factor in your depression isn’t your unlucky
genes or your rough childhood. The weakened homeostatic
system that allows depression into your life is, above all, a
problem caused by the way you live.
How do I know this is?
Well, let’s conduct the Bad Bulb Test, and see.
When I was growing up, Christmas tree lights had an an-
noying characteristic: When a bulb burned out, all the bulbs
in the string went out. In order to get the string to light up
again, you had to fnd the burned-out bulb and replace it.
But since the entire string was dead, the bad bulb looked the
same as all the good ones. So you had to go through the string
bulb-by-bulb, replacing each one to see if it made the string
light up. When it did, you knew you had found the bad bulb.
It was an odd kind of detective work. You found out where the
problem was only after you corrected it.
NA T U R E , NU R T U R E A N D ¡ U R N ¡ T U R E ¤;
As a psychotherapy client, I replaced several bad bulbs,
unscrewing some of my screwy ideas and replacing them
with more realistic notions. In this way, I solved a few per-
sonal problems that had been caused by my own thinking.
But the problem that psychotherapy wasn’t able to help me
with was my depression, and this failure suggested that, al-
though psychotherapy did a good job when it came to certain
kinds of distorted thinking, the bad bulb that darkened my
moods was something that psychotherapy didn’t address. I
was in the majority of psychotherapy clients who come away
from therapy with valuable lessons yet stay depressed.
to conclude it was something other than my thinking that
was depressing me.
Similarly, when I tried Prozac and it didn’t work any bet-
ter for me than it does for most patients who try it, that was
evidence that the problem wasn’t something addressed by
But then, when I made some changes in my life and my
life lit up, I knew I’d found the bad bulbs that had been caus-
ing my problem. Seeing the difference these changes made
showed me what had been wrong all along.
Medical research provides a wealth of Bad Bulb Tests
that extend the conclusions that I reached for myself to
Studies at the University of Texas
and other re-
show that adding even a little ex-
ercise lights up your life, reducing depression. And
if you exercise harder, longer, or more often, the
lights get even brighter.
Bad bulb found.
Studies reported by the National Science Founda-
and the National Sleep Foundation
that if you undersleep like most people, getting one
UP W ¡ T H O U T ME D S ¤8
or two hours’ more sleep every night lights up your
life, reducing depression. Bad bulb found.
Studies at Harvard
and other research centers
show that making just one small change in your
diet—adding signifcant amounts of Omega-3 fatty
acids, a nutrient in fsh—lights up your life, reduc-
ing depression. Make more diet changes, the re-
search shows, and the lights get even brighter. Bad
Studies at the University of Michigan
show that increasing your social
support lights up your life, reducing depression.
Bad bulb found.
Studies at the Royal Edinburgh Hospital
er research centers
show that giving up alcohol or
another addictive substance lights up your life, re-
ducing depression. Bad bulb found.
What all these studies don’t tell you is that if you combine
all the individual changes that have proven to be effective,
depression doesn’t just recede. It ends altogether.
As I discussed in Chapter 1, the scientifc method requires
scientists to focus on only one issue at a time. This means
that each research study can provide only a “one-tree” view
of reality. The investigator who demonstrates that exercise
reduces depression symptoms has little professional interest
in learning that better sleep habits have a comparable effect,
and the scientist who proves that a good night’s sleep im-
proves buoyancy may have only the most casual awareness
that a change in diet also helps. It’s up to you and me, who as
nonscientists aren’t limited to a narrow view, to understand
NA T U R E , NU R T U R E A N D ¡ U R N ¡ T U R E ¤¤
that when you replace all the burned-out bulbs, and not just
this one or that one, the dark night of depression is over.
But even scientists have to be impressed by another type
of evidence, provided by groups of people who suffer low
rates of depression.
The last undepressed generation
Consider the War Generation, people my parents’ age who
became adults in the 1930s and early 1940s. They lived quite
differently from the way we do today, not because they were
wiser than we are, but because they didn’t know any other
way to live. They make a good test case.
To begin with, they were more active than we are. Most of
them didn’t earn their living in sedentary ways, as we do.
The majority of them, whether they were employed outside
the home or were housewives, did a lot of physical work.
And when they weren’t working, they were often still moving.
They walked more miles than they drove.
They played more
sports than they watched.
They pushed manual lawnmow-
ers, churned ice cream using muscle power, and hauled fur-
nace ashes in buckets. For most people, just getting through
the day provided a workout.
This generation had better sleep habits than we do, too. It was
before late-night television, the Internet, and the DVD player
began tempting people away from their beds, and before a
large number of Americans started encountering sleep prob-
lems because of shift work. The members of the War Genera-
UP W ¡ T H O U T ME D S qo
tion slept, on average, over an hour more than we do today
(but still an hour less than their grandparents
Less harmful food
Their diet was radically different from ours, too. They ate less
refned sugar, refned carbohydrates, and saturated fats than
Their bodies weren’t subjected to harmful products
like high-fructose corn syrup, trans fats, and most of the
polysyllabic food additives listed on processed food packag-
es today, because these products weren’t on the market yet.
They ate more vegetables, fruits, whole grains, and unpro-
cessed foods than we do.
And they ate less than we eat—six
hundred calories a day less
—even though they burned more
Sixty years ago in the U.S. there was more social connection
at every level of society. People of the War Generation got out
more and were more involved with other people than we are
today. They went to club meetings and church functions more
often, entertained in their homes more often, visited neigh-
bors more often, went out with the girls or the guys more
often, helped out other people more often, and ate with their
families more often.
If something went wrong in their lives,
they weren’t so much on their own, because a friend or neigh-
bor was usually there to help.
For the War Generation, the rate of alcoholism was about the
same as it is now,
and people smoked more then,
plethora of other addictions that snare people today were far
less prevalent, when they existed at all. These include recre-
NA T U R E , NU R T U R E A N D ¡ U R N ¡ T U R E q1
ational and addictive prescription drugs, food, gambling, In-
ternet, television, video games, compulsive recreational sex,
pornography, and compulsive shopping.
In rough numbers,
alcoholism today strikes one out of ten U.S. adults,
a conservative guess is that fve times that many people are
addicted to something besides alcohol.
If you defne addic-
tion broadly, as a dependency that impairs people’s health but
doesn’t necessarily wreck their lives, there are more addicts
in this country than there are Republicans or Democrats.
Mind you, I’m not making a case for turning the clock
back. Today, compared with sixty years ago, we have more
social justice, increased tolerance for people different from
us, better health care, safer working conditions, greater pros-
perity, cheaper food, more conscientious child rearing, safer
cars, fewer war deaths, more educational opportunities, more
information sources, more entertainment options, more ac-
cess to the fner things of life, and a wealth of other advantag-
es. But what was good about the Good Old Days is that some
essential needs were routinely met, just in the normal course
of life, that aren’t being met for many people today.
An eight-fold depression increase in sixty years
This year about seventeen million Americans will experience
at least one episode of major depression.
In 1950, the num-
ber was one million.
If you adjust for population growth, the
rate sixty years ago was one-eighth what it is today.
nothing less than a sea change that has taken place in just
three generations. What else could be the cause other than
another sea change that has occurred simultaneously—the
radically different way we live?
Combine this logic with the fact, established by research,
that depression recedes when you put back the exercise,
UP W ¡ T H O U T ME D S qz
sleep, or any of the other essentials that modern living has
taken away, I’d say it’s an open-and-shut case.
Stress gets a bum rap
Some people believe that we have more depression today
because of greater emotional stress. But do we? My parents’
generation lived through the Great Depression. Then, as Hit-
ler marched across Europe, they had to deal with the very
real possibility that civilization would soon end. A few years
later, fearing the bomb and afraid of polio, they built shel-
ters in their homes and kept their children home from the
swimming pool. Their day had an hour less leisure time in
They worked and lived under tougher conditions,
injured more frequently,
contracted diseases more easily,
and saw more of their children die young.
Perhaps we indulge in a perverse oneupsmanship when we
think we endure more stressful circumstances than they did.
The reason we’re more depressed than they were surely can’t
be that living conditions have become harsher, because they
haven’t. Logic tells us that depression is booming today not
because of the world we live in, but because of the way we live
in the world.
The people who stopped the world and got off
If the War Generation provides a good test case for depres-
sion theories, the Amish may serve even better. These people
live very much as folks did a hundred years ago, eschewing
motorized conveniences in favor of horse-drawn alternatives
and manual labor. Having no television to keep them up late,
they turn off their oil lamps before the late movie begins for
the rest of America, and retire for a full night’s sleep.
eat wholesome organic foods, including a steady diet of fresh
NA T U R E , NU R T U R E A N D ¡ U R N ¡ T U R E q¤
vegetables and fruits they grow themselves.
They are im-
mersed in a community of social support.
Addiction is all
but unknown among them.
If avoiding the lifestyle problems imposed by modernity
is the way to avoid depression, the Amish should be pretty
much free of it. Are they?
For twenty-fve years Janice Egeland, a medical sociolo-
gist, studied the Amish of Lancaster County, Pennsylvania.
Using the same diagnostic tools that have shown depression
doubling every generation in the general population, Egeland
found that the increase never took place in this community.
Their rate of depression is the same as my grandparents’ gen-
eration—which is to say, almost nil.
Encountering Plain People, as they’re known, when I visit
my sister and her family, who live in Ohio’s Amish country,
I observe that they don’t exactly look like the life of the par-
ty. But it’s not depression I see. Their poker faces are due to
an ethos that discourages any kind of public expression that
might draw attention.
Inside, where it counts, they are alive
and well. They don’t need the antidepressants that their cul-
ture disdains, and no one ever dies for want of a telephone
to call the suicide hot line. It’s a call the Amish never need to
And lest you think the Amish may be covering up their
problems to protect their image or are just being stoic, Ege-
land found that unipolar depression is the only mental-health
trend where they haven’t kept up with the rest of us. Their
rates of bipolar disorder, schizophrenia, and virtually every
other mental problem are the same as everyone else’s.
UP W ¡ T H O U T ME D S qq
Evidence in your own backyard
How about your own family and other families who are
friends? How many people born a few generations back did
you know who were depressed? In comparison, how many
people in your generation are? And how many people in the
next generation are? My family, for one, perfectly refects the
national statistics. I knew all four of my grandparents well,
and am certain that none of them were depressed. Cumu-
latively, they had fve children, one of whom, my mother,
was depressed. My mother had four children, two of whom
were depressed. And among the seven grown children of my
parent’s children, four have been depressed. These are small
numbers to be sure, but they tell the same story the big num-
bers tell: The frst generation in this short genealogy had zero
cases of depression; then there was one; then two; then four.
Like many families, we Myerses like to think we’re special.
But when it comes to depression, we couldn’t be more aver-
Is it just better diagnosis?
Has depression really increased, or do new diagnostic and
reporting techniques just bring cases to light that would have
been hidden sixty years ago? It’s not likely. For one thing, our
diagnostic and reporting methods haven’t changed during
most of the period in which depression has kept doubling.
We measure depression today the same way they were mea-
suring it in 1960, when they found only a fraction of the cases
they’re fnding now. The two standard tools currently used
to test for depression, the Hamilton Depression Rating Scale
and the Beck Depression Inventory, are now almost ffty
Depression statistics keep going up not because
NA T U R E , NU R T U R E A N D ¡ U R N ¡ T U R E q=
of more sensitive instruments but because the same instru-
ments are detecting more depression.
Is there just more whining?
Some doubters have suggested that we aren’t really more de-
pressed than people used to be, we’re just more self-involved,
more self-indulgent, or more open in discussing our prob-
lems. One man said to me, “Sixty years ago, if someone was
depressed, he just didn’t think about it.” But if people were
less aware of being depressed sixty years ago, that wouldn’t
have been enough to produce an undercount, compared with
today. Then, as now, researchers understood that most de-
pressed people don’t realize what their problem is.
pensate for this, interviewers have always been trained to
spot depression using a kind of detective work that doesn’t
depend on the subject’s self-diagnosis. That’s what the Ham-
ilton Depression Rating Scale is used for.
Is it just a response to advertising?
Could the depression epidemic be a creation of Big Pharma, a
result of the companies’ just talking more of us into believing
we’re depressed so they can sell more product? They do sell
more product, but not because a substantially larger number
of people are correctly interpreting their symptoms. Most
depressed people remain, even today, unaware that they’re
depressed until they get diagnosed, and primary care physi-
cians, who are the gateway for all ailments, still miss the di-
agnosis most of the time, in spite of all the antidepressant ad-
vertising directed at them.
The drug companies’ marketing
has succeeded brilliantly in making pills the favored treat-
ment for depression, but hasn’t affected diagnosis, including
self-diagnosis, to a great extent.
UP W ¡ T H O U T ME D S q6
The Furniture Factor is hazardous to your health
In this book I focus on depression as the price you pay for a
heedless lifestyle, but keep in mind that this way of living can
dramatically affect your physical health as well, though the
results are often hidden until you reach middle age. In 2007
a research group at the University of Pennsylvania reported
the results of a study involving twenty thousand Americans
over the age of 50. It was sponsored in part by the National
Institute on Aging, a component of the National Institutes
of Health. The study found that Boomers now in their early
and mid-50s suffer from poorer health, more pain, and more
diffculty doing everyday physical tasks than their parents
did at the same age.
If present lifestyle trends continue, the
generation that comes after the Boomers will ride the couch
into an even more medically troubled midlife than those who
are now feeling worse than their parents were feeling twenty
But you can choose to buck this trend. With some support
from friends, family, or a professional therapist or coach, you
can reverse the downward curve that’s depressing so many
Americans and bringing on physical illness and premature
old age. And for additional help, you’ll fnd personal, live
guidance and support at 5decisions.com.
You can become stronger, healthier, and more depression-
free than the people before you, and surpass the younger peo-
ple coming up behind you as well. All it takes is putting back
in your life the essential things that modern living has taken
away. Just do that, nothing more, and you’ll enjoy even better
buoyancy than those who were lucky enough to be born with
two antidepressant genes. Depression will then exit your life
like a worn-out old sofa headed for the landfll.
F O U R
no P i L L Cu r e s s t A r vA t i o n
At b e s t , a n t i d e p r e s s a n t s
t u r n b l a c k mo o d s i n t o g r a y o n e s .
magine how outraged everyone would be if the World
Health Organization proposed to give diet pills to starv-
ing people in developing countries, arguing that it would
dull their hunger. Yet no one bats an eye when pills are pre-
scribed for depressives who are starved for things that are
almost as basic to human wellbeing as food.
Since antidepressants don’t address the underlying causes
of depression any more than diet pills address starvation,
they often don’t work, and when they do, it usually isn’t for
the reasons given by the drug companies. Many people who
try antidepressants see no improvement at all,
those who do improve, the change is often slight.
Drugs don’t promise, and can’t promise, to
end depression for anyone.
Indisputably, drugs have provided a welcome modicum of
help to many people and have even saved lives by sometimes
easing depression enough to head off severe health problems
that are associated with depression like heart disease, and
even prevent suicide in some cases. Yet there is another side
to the story, told in the personal histories of people you and
I know and in every independent research study ever pub-
lished. It’s the story of the little pill that couldn’t.
But if you are one of the exceptions—if drugs are work-
ing well for you and you’re willing to put up with the side
effects—I suggest that you stick with them, because any help
you can come by is worth having. If you’re on antidepres-
UP W ¡ T H O U T ME D S q8
sants, it won’t interfere at all with the recommendations I’m
going to be making in this book.
It is estimated that close to half the people who are suf-
fering from major depression are on medication for it,
studies indicate that as many as 80 percent of those who take
drugs get depressed again.
This is a relapse rate similar to
what you’d fnd among people who aren’t treated at all. As J.
Moncrieff of London’s Charing Cross Hospital writes in the
Journal of Nervous Mental Disorders, “There are no signs
that the rapidly escalating use of antidepressants is reducing
the burden of depressive disorders.”
Doctors aren’t getting it done.
The problems with antidepressants start with the profession-
als who prescribe them. In 2003 the Journal of the Ameri-
can Medical Association reported on a Harvard study which
found that, according to commonly accepted medical stan-
dards, only one in fve patients receiving medical treatment
for depression gets adequate care. This is so, the study con-
cluded, because most people who are depressed—70 percent
of them—go to a primary care physician for help, and, to put
it in only slightly plainer language than the study did, pri-
mary care doctors, as a group, don’t know how to take care of
Few general practitioners are trained in clinical psychol-
ogy, so no one expects them to offer anything but the most
rudimentary forms of psychotherapy, if they even take the
time to do that. Drugs, however, are very much in their line
of work, and they write vast numbers of prescriptions for an-
tidepressants. But, according to the Harvard study, there is
a problem with these prescriptions—or rather, a whole set of
problems. Frequently, primary care physicians prescribe the
wrong product, specify the wrong dosage, fail to monitor the
NO P ¡ ¡ ¡ C U R E S S T A R V A T ¡ O N q¤
patient closely enough, or keep the patient on the medication
for the wrong period of time. In fact, doctors make one or
more of these mistakes more often than not.
Most depression goes untreated
There are plenty of people who go to the doctor depressed
and get no treatment at all. When researchers tracked a
group of primary care patients who said they were having
serious emotional problems, they found that doctors spotted
the mood disorder only 18 percent of the time.
depressed people don’t tell a doctor they’re depressed, but
complain of fatigue, sleeplessness, sore muscles, or other
physical symptoms that often accompany depression.
doctor who isn’t trained to see the hidden message in these
complaints—and most primary care doctors aren’t—will of-
ten address the physical symptoms and miss the underlying
condition. Frequently, a person whose life is being wrecked
by depression will leave the doctor’s offce with a prescrip-
tion for sleeping pills.
Doctors who can’t be bothered
There is evidence that doctors’ blindness to depression is
sometimes willful. General practitioners, trying to squeeze in
as many patients as possible and pressured by HMOs to limit
the average patient “encounter” to seven minutes, frequently
feel that they don’t have time to ask a patient the questions
that might reveal a mood disorder.
Many doctors believe that under managed care they aren’t
fairly compensated for the extra time needed to treat depres-
sion adequately. As one doctor told the New York Times, “I
see so many patients a day, I don’t want to open up a can of
UP W ¡ T H O U T ME D S =o
Are specialists the answer?
One study found that mental-health specialists meet mini-
mum professional standards about 60 percent of the time.
That’s better than non-specialists do, but still not reassuring.
Imagine how we’d react to the news that only two out of three
surgeons were doing their job right.
But even if you’re able to fnd a knowledgeable and con-
scientious professional, her ability to help you is limited by
the fact that every weapon in her pharmacological arsenal
frequently misfres. When your doctor prescribes an antide-
pressant for you, she can’t know whether it’ll work, or whether
it’s completely safe.
All she can do is rely on her limited per-
sonal experience with other patients and on what she’s been
told over and over through billions of dollars of advertising
in medical journals and a hundred thousand drug salesmen
(predominantly women, actually) who blanket every medical
offce in the U.S. each week.
In a 2007 Time piece, the orthopedist Scott Haig says the
drug reps, known among physicians as “pharma babes” be-
cause drug companies prefer to hire “young, attractive women
without pharmacology education,” may have an even greater
infuence on what he himself prescribes than the HBOs and
hospitals he works for. “While those stern voices tell [us what
to prescribe],” he says, “the friendly pharma babe…is often a
more forceful persuader.”
So if you follow the instruction given to you in the drug
commercial—“ask your doctor”—the answer you get is the
drug companies’ answer, communicated to doctors by
When you take medicine, you assume, quite reasonably,
that objective scientifc studies have proven the medicine
to be safe, effective, and appropriate for someone suffering
from your particular condition. But the studies cited by drug
NO P ¡ ¡ ¡ C U R E S S T A R V A T ¡ O N =1
company ads aren’t objective, and aren’t even particularly
scientifc. This is because the companies themselves have
captured the system that’s doing the testing
A 2006 review of published research on psychiatric drugs,
undertaken by a group at Beth Israel Medical Center in New
York, showed that the percentage of studies sponsored by
drug companies, as opposed to independent researchers,
more than doubled from 1992 to 2002, reaching 57 percent.
This means that most of the “scientifc” information that doc-
tors and patients rely on for assessing the effcacy of these
drugs now comes straight from the companies that make
An editorial in the May 18, 2000, issue of the New Eng-
land Journal of Medicine, titled “Is Academic Medicine for
Sale?” made the astonishing assertion that the NEJM’s usual
practice of disclosing the authors’ ties to drug companies had
to be suspended for a report on a study of the antidepres-
sant Serzone. Why? Because the apparent conficts of inter-
est “were so extensive that it would have used too much space
to disclose them fully....”
“There is now considerable evidence,” the editorial said,
perhaps belaboring the obvious, “that researchers with ties
to drug companies are...more likely to report results that are
favorable to the products of those companies than research-
ers without such ties.”
Researchers, knowing their fnancial relationships with
drug companies undermine the credibility of their studies,
sometimes cover up those relationships. On three separate
occasions in 2006, the Journal of the American Medical As-
sociation announced that it had been misled by researchers
who failed to disclose their income from drug companies.
In the second embarrassing episode, most of the thirteen au-
UP W ¡ T H O U T ME D S =z
thors of an antidepressant study had received payments, but
only two doctors acknowledged them.
The Beth Israel review showed that when a company’s
fngerprints are on a study, it usually comes out in the drug’s
favor, while independent studies more often show a drug
doesn’t work. Studies paid for by drug companies pronounced
the drugs effective 78 percent of the time. The success rate
in studies that weren’t backed by industry money was just 48
When researchers taking money from a drug com-
pany aren’t able to concoct favorable results, drug compa-
nies sometimes hide the negative study. In the trade, this is
known as the “fle drawer effect.” In 2002 the University of
Connecticut’s Irving Kirsch, suspecting that companies were
concealing unfavorable antidepressant research, used the
U.S. Freedom of Information Act to bring all the data, both
favorable and unfavorable, out into the open. It turned out
that many studies had, indeed, been buried in the fle drawer,
and these concealed studies tended to show that antidepres-
sants produce poor results.
The weakness of the principal government agency that
regulates the industry, the U.S. Food and Drug Administra-
tion, encourages drug companies to cheat. In 2006 the New
York Times reported on an independent review by a non-
proft agency created by Congress, the Institute of Medicine,
that “derided the Food and Drug Administration as a feckless
watchdog unable to protect consumers from unsafe medi-
Since we can’t count on doctors, drug companies, or even
the FDA for reliable information, let’s do our own review of
the research, and ask whether there’s any substantial evi-
dence to support the claim that pills can reliably reduce de-
NO P ¡ ¡ ¡ C U R E S S T A R V A T ¡ O N =¤
According to the largest study of antidepressants ever
done, the one sponsored by the National Institutes of Health
in 2005, antidepressants don’t work at all for about half the
people who try them.
Other studies suggest that among the
patients who get some relief, most see only a modest improve-
And even that change, it is now clear, owes far more
to psychology than to pharmacology.
Medicine versus sugar
In clinical trials required by law for approval of a new drug,
researchers compare the drug’s results to those produced by
a placebo, usually a sugar pill. This is done to separate out
any improvement that’s due to the patient’s belief in the pill,
as opposed to its real medicinal properties. If a drug does
signifcantly better than a placebo—meaning that it performs
at least slightly better than a sugar pill—it is considered an
effective treatment for the purposes of regulatory approval
and advertising. If it doesn’t beat the sugar pill, it is consid-
ered inert. “Inert” means that pharmacologically, it has no
The clinical trials submitted to the FDA by drug compa-
nies demonstrate that antidepressants are better for treating
depression than sugar, but only slightly better. After Irving
Kirsch of the University of Connecticut forced the FDA to
release data that had been concealed, he and his colleagues
published a landmark paper in the journal Prevention &
Treatment that reported the results of the most thorough
review of antidepressant clinical trials ever done up to that
point. The survey looked at the data for all studies submit-
ted by the drug companies between 1987 and 1999 for the
six most widely prescribed antidepressants approved during
that period. These drugs were Prozac, Paxil, Zoloft, Effexor,
Serzone, and Celexa.
UP W ¡ T H O U T ME D S =q
Antidepressants are placebos
Kirsch found that when the data from all forty-seven studies
were compiled and analyzed, the placebo effect accounted for
about 80 percent of a drug’s effectiveness.
This means that
patients taking a sugar pill improved almost as much as those
taking the real medicine. It became obvious that almost the
entire effect of the drugs was in the patients’ minds.
No one has disputed the validity of Kirsch’s studies. The
psychiatrist Michael Thase, even while defending antidepres-
sants in the journal Psychiatric Times, acknowledged that
“there is now no doubt that nonspecifc factors (i.e., placebo,
expectancy, social support, spontaneous remission) account
for a majority” of the improvement achieved by antidepres-
sants in clinical trials.
But even the small share of improvement that pills might
legitimately take credit for is open to question. Clinical trials
exaggerate improvement by declaring the most unsuccess-
ful third of their research subjects to be non-subjects. People
who start the study but drop out aren’t counted. Typically,
that’s 30 to 40 percent of the sample.
By declining to count
these people as treatment failures, researchers are burying
their worst mistakes. If you assume that a large number of
patients in drug trials quit because the drug isn’t working
for them and perhaps even because they’re too depressed to
make it to the research lab, it means the percentage of those
who don’t respond at all to antidepressants in clinical trials
could be as high as 50 percent, exactly the same rate of fail-
ure that the large NIH study reported.
Mainstream medicine has lately developed great respect
for the curative power of belief. Doctors have even started
using the placebo effect to treat physical ills, particularly
those for which no diagnosis is found. The July, 2006, issue
of the Journal of General Internal Medicine reported that
NO P ¡ ¡ ¡ C U R E S S T A R V A T ¡ O N ==
researchers at Michigan State University have developed a
treatment that relieves unexplained symptoms of all kinds,
including back pain, headache, fatigue, and problems in-
volving the joints, nervous system, stomach, and intestines.
The treatment is a combination of cognitive therapy, bedside
manner—and, of all things, antidepressants.
sants are now anti-back-pain, anti-sore-knee, anti-stom-
ach-cramp, and anti-bloating drugs. According to the study,
half of all patients with symptoms but no apparent disease
improve markedly with this treatment—the same percent-
age, interestingly enough, as the proportion of depressed pa-
tients who are helped by antidepressants.
It makes perfect
sense: Imaginary diseases are now being cured by imaginary
Are fake medicines so bad, really?
All things considered, how important is it whether the source
of relief is the body or the mind? If some people feel better
when they take a sugar pill—or even a “real” drug that hap-
pens to behave no differently than a sugar pill—what’s the
It’s a valid point. We can be grateful that there are sig-
nifcant numbers of patients who are less depressed simply
because they believe in the medication they’re taking. You
could even argue that the billions of dollars in antidepres-
sant drug advertising and promotion each year may be do-
ing more good than the scientists who are formulating and
testing the drugs. By convincing people that these drugs are
powerfully medicinal even when they aren’t, the sales pitch,
when it is believed, enables both doctors and patients to join
in a form of faith healing.
UP W ¡ T H O U T ME D S =6
Yet even when the power of belief provides some relief,
meds still don’t come close to curing anything. Typically, at
best, they do no more than turn black moods into gray ones.
Measuring shades of darkness
The Hamilton Depression Scale (HAM-D) is the standard tool
used in antidepressant drug trials and in many other types of
studies to measure depression in a patient. It is a seventeen-
item, multiple-choice questionnaire that a test administrator
flls out as she interviews the patient. The score, indicating
the severity of depression, is based on the patient’s answers
to questions, together with the administrator’s observations
of the patient. For example, the patient is asked whether her
mood is affecting her thoughts and feelings about work, and
whether it has interfered in any way with work. The admin-
istrator gives her a score from 0 to 4, depending on her an-
swers. A score of 0 indicates no problems with work, and 4
indicates the worst case, in which she has stopped working
because of her illness. During the interview, the administra-
tor observes the patient’s body language and other cues so
the administrator himself can determine the answers to ad-
ditional questions, for example about the patient’s physical
agitation, ranging from none (0 points) to “hand wringing,
nail biting, hair pulling, biting of lips” (4 points). The maxi-
mum possible score, meaning that the patient is at the ex-
treme depths of measurable depression, is 50 points.
When he combined the results of all forty-seven trials
submitted to the FDA between 1987 and 1999, Irving Kirsch
found that the average improvement for people taking the
placebo was 8 points on the Hamilton Depression Scale. For
people taking the real antidepressant, it was only 2 points
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How much improvement does 10 points represent? To get
an idea, we can designate ranges in the HAM-D scale: 7-16
for mild depression, 17-26 for moderate depression, 27-36
for severe depression, and 37 and above for depression that
probably requires hospitalization. If you divide up the scale
this way, it means that the drug moves the patient down just
one level of severity, from should-be-hospitalized to severe-
ly depressed, or from severely depressed to moderately de-
pressed, or from moderately depressed to mildly depressed,
or from mildly depressed to normal. The drug can’t reliably
improve the condition of the average patient who is severely
depressed to the point where she is only mildly depressed,
much less help her achieve full recovery. For example, the
most an antidepressant can be expected do for the worst case,
a person who may be about to attempt suicide, is improve her
condition to the point where she’s just thinking about killing
herself. This is a valuable improvement to be sure, and a pre-
cious one if it actually saves someone’s life. But it is not a so-
lution that we should ever be satisfed with. If penicillin were
as poor an antibiotic as Zoloft is an antidepressant, you and I
and most of the people we know might not be alive today.
The downside is real enough
Ineffcacy is only half the story. The other half begins at the
end of the Zoloft commercial, when the side effects are recit-
ed. But that’s not the whole story, either, because disclosure
of the side effects plus all the other problems that aren’t men-
tioned would require extending a sixty-second commercial to
full newscast length, and would sound something like this:
UP W ¡ T H O U T ME D S =8
About 70 percent of people who take the most-prescribed
class of antidepressants, SSRIs, lose some sexual desire or
About a third quit because of this, or because of
nausea, drowsiness, weight gain, ringing in the ears, or other
Eli Lilly, the maker of Prozac, says that, in addition to
sexual dysfunction, the drug causes nausea in 23 percent of
patients, insomnia in 20 percent, drowsiness in 13 percent,
diarrhea in 12 percent, tremors in 10 percent, and rashes or
hives in 7 percent.
Many patients suffer from two or more
In 2004 the U.S. Food and Drug Administration issued
an advisory warning that the top-ten-selling antidepres-
sants, including Prozac, Zoloft, and Paxil, can cause “anxi-
ety, agitation, panic attacks, insomnia, irritability, hostility,
impulsivity, akathisia (severe restlessness), hypomania, and
Finding out whether drugs will work for a given individual,
and which drugs, and how well, and with what side effects,
is purely a matter of trial and error.
When a drug doesn’t
work, all the patient can do is ask her doctor to try changing
the prescription, wait up to six weeks or more to see if the
new drug helps, and hope the side effects that accompany the
next adventure in pharmacology aren’t worse than those of
the drug that failed her.
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Among those who keep trying until they fnd a drug that helps
them, it eventually stops working 20 percent of the time.
Then it’s back to the doctor’s offce.
Dr. Andrew Leuchter of UCLA, who in 2005 helped manage
a 35-million-dollar study of long-term antidepressant treat-
ment sponsored by the National Institutes of Health, told the
New England Journal of Medicine, “The side effects are im-
mediate. The therapeutic benefts take a long time.” In fact,
the study showed that, among the patients who got some re-
lief, half of them didn’t notice any change for the frst eight to
ten weeks of the study.
Taking an antidepressant, plus going to a doctor for monitor-
ing, can cost you, every month, the equivalent of a monthly
payment on a midsize car.
Insurers prefer to pay for health-
care only from the neck down, and rarely cover more than
half the cost of antidepressant treatment. Paying thousands
of dollars out of your own pocket is especially galling, of
course, when the treatment doesn’t work.
In one study, 15 percent of the respondents said that antide-
pressants deepened their depression.
Some studies suggest
that antidepressants may increase the risk of suicide, espe-
cially for younger people.
The FDA now requires packaging
for the most-prescribed type of antidepressants, SSRIs, to in-
clude a warning that SSRIs double the risk of suicide.
UP W ¡ T H O U T ME D S 6o
Dangerous interactions are possible when antidepres-
sants are taken with certain other medications or recre-
ational drugs. In 2006 the FDA issued an alert warning that
antidepressants combined with the popular migraine drugs
known as triptans could be fatal.
There are no studies on the possible hazards of long-term
use. The FDA has approved antidepressants as safe only for
a period of six to twelve months, which means that the mil-
lions of people who stay on them for years have no assurance
that the drugs won’t eventually cause serious problems.
In 2006 a report presented to the annual meeting of the
American Diabetes Association stated that antidepressants
boost the risk of Type 2 diabetes two to three times among
people who are already at greatest risk.
A 2007 study by researchers at McGill University in Can-
ada found that selective serotonin reuptake inhibitors, the
most popular antidepressants, reduce bone density in people
over 50, increasing the risk of fractures.
Antidepressants taken by a pregnant woman can harm
the baby. According to a study published in the Archives of
Pediatric & Adolescent Medicine, more than a third of the
babies born to mothers on SSRIs, the most widely prescribed
antidepressants, suffer withdrawal symptoms.
New England Journal of Medicine reports that babies born
to mothers on these drugs are six times as likely to suffer
from persistent pulmonary hypertension, a dangerous condi-
tion in which blood fails to circulate through the lungs.
When you go on antidepressants or any other drug, you’re
at the mercy of often hurried, overworked, error-prone peo-
ple, who aren’t always careful with these potentially danger-
ous products. In 2006 the Institute of Medicine, an arm of
the National Academies of Science, released a study showing
NO P ¡ ¡ ¡ C U R E S S T A R V A T ¡ O N 61
that more than 1.5 million Americans are injured every year
by drug errors made by caregivers.
With drugs of any kind, and especially newer antidepres-
sants for which there isn’t a lot of real-world data, you always
have to worry about the unknown unknowns, the unk unks,
as technical people call them. How many times have we been
shocked by an announcement that a familiar drug long con-
sidered safe is now believed to harm some people? We surely
know by now that any drug, no matter how benign they said
it was when it came on the market, can suddenly make head-
lines as a potential killer.
In fact, there is no study so large, and no reporting jour-
nal so prestigious, that you can ever fully trust the safety as-
surances that you read. In 2005 the drug company Merck re-
ported on a study of its now-infamous arthritis medication,
Vioxx, which has been shown to increase heart attack risk.
The study involved twenty-six hundred patients, and the re-
sults were reviewed by and then reported in the New England
Journal of Medicine.
According to Merck, the study showed
that Vioxx increased heart problems only after a patient took
it for eighteen months. A drug that waits a year and a half
to start harming people is frightening enough, but the study
did undoubtedly reassure those patients who had discontin-
ued it early. However, a year later, Merck “discovered” that
the eighteen-month safety period doesn’t really exist. The
company’s claim, they said, had been based on a “statistical
error.” Vioxx, the “reinterpretation of data” showed, begins
killing people quite quickly.
One example that would be funny if it weren’t so scary:
In 1989, Canadian researchers discovered that chemicals
naturally occurring in grapefruit juice, known as furanocou-
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marins, increase the effect of certain blood pressure drugs
so much that the meds become lethal.
Since then, the list
of medicines that interact dangerously with grapefruit juice
continued to grow, and now includes some cholesterol-low-
In 2006 the New York Times reported that
SSRIs, the most widely prescribed antidepressants, are
among the products that behave dangerously when taken
The phrase that doctors are now using to describe what hap-
pens to some people when they stop taking antidepressants,
discontinuation syndrome, is a euphemism for addiction
withdrawal. Up to a third of those in treatment experience
unpleasant effects, including nausea, fu-like symptoms,
anxiety and sweating, when they go off antidepressants.
Labels for SSRIs now note that “intolerable symptoms”
are possible when the drugs are discontinued. In Europe it
is illegal to use the phrase “non-habit forming” in SSRI ad-
The World Health Organization makes no bones
about it. They say SSRIs are addictive.
Some medical professionals believe that drugs are more
effective when they’re combined with psychotherapy. The
poster child for this approach is a study reported in the May
18, 2000 issue of the New England Journal of Medicine. In
this study, severely depressed patients, averaging 27 on the
Hamilton Depression Scale, improved to the point where
they were only mildly depressed, hitting 10 on the scale after
twelve weeks of cognitive-behavioral therapy combined with
the antidepressant Serzone.
Reducing a patient’s depression by 17 points is an impres-
sive performance, especially compared with the usual results
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reported in drug trials. But the glow fades when you read the
report’s fne print.
To begin with, the research subjects were the cream of the
depressed crop. So many people were kept out of the study,
including those with suicidal tendencies, drug problems,
severe phobias, acute anxiety, and eating disorders, it’s sur-
prising there were any depressives left as research subjects.
And, as usual, dropouts—in this case almost 40 percent of
the people who were there at the beginning—weren’t counted
in the fnal result.
Not what you would call an independent study
But the most troubling fne print was the disclosure that
Bristol-Myers Squibb, the maker of Serzone, sponsored the
study, and that, as the publication pointed out in an editor’s
note, “all but 1...of the 12 principal authors have had fnancial
associations with Bristol-Myers Squibb...and, in most cases,
with many other companies producing psychoactive phar-
Serzone’s surprise ending
Still, this effort would count as something of a success story
if it weren’t for one fnal chapter. In 2003, three and a half
years after the study’s authors were giving each other high
fves, Squibb made this announcement:
It has come to the attention of Health Canada that nefazo-
done (Serzone) has been associated with adverse hepatic
events including liver failure requiring transplantation in
Canada. Following discussions with Health Canada, Bris-
tol-Myers Squibb Canada has decided to discontinue sales
of nefazodone [in Canada]....
UP W ¡ T H O U T ME D S 6q
Note the suggestion in the phrase “Bristol-Myers Squibb has
decided” that Squibb was given a choice by Canada’s govern-
ment (they weren’t, of course), and the odd implication that
Serzone-caused liver failure is just a local problem that ap-
plies only to Canada, perhaps the result of Canadians’ being
less robust than those who get more sunshine. However, the
FDA found, not too surprisingly, that Americans, too, could
die from taking Serzone, and ordered Squibb to start printing
a notice on the label warning of “rare reports of liver necrosis
and liver failure, in some cases leading to liver transplanta-
tion and/or death.”
Six months later, in a classic case of slow, time-release dis-
closure, the FDA ordered Squibb to remove the word “rare”
from the notice.
It’s understandable that people would want to believe
drug companies and doctors who tell them that antidepres-
sants could be the solution to their problem. Depression is so
painful—and taking a pill so easy—that when the doctor gets
out his prescription pad, it’s an offer you almost can’t refuse.
But like so many promises made by people who have proft
objectives to meet or too many patients to see, the promises
are often not kept. It’s too bad they can’t be, because many
sufferers would be willing to pay even more out of their own
pockets, wait even longer for results, put up with even more
side effects—if the damned things really worked. But since,
for many of us, they don’t, it’s up to us to fnd out what does.
Acknowledging the disappointing truth about antidepres-
sants can help us face the true causes of depression and come
to an understanding that our own bodies already have what
it takes to cure us if we let them. The splendid pharmaco-
logical operation within us is ready and able to do, at no cost,
what no two-buck pill ever can.
F I V E
Ps y C h o t h e r A P y :
Wh y yo u C A n ’ t tA L k yo u r
WA y ou t o f De P r e s s i o n
I t ’ s l i k e f i g h t i n g a f o r e s t f i r e
b y a t t a c k i n g t h e s mo k e .
s a group, psychotherapists are more depressed than
the rest of us.
Does this tell you something?
Psychotherapy can be helpful in dealing with
many personal problems, but the record shows that talking
to a therapist almost never ends depression.
The most ambitious study ever done on depression treat-
ments, by the National Institute of Mental Health (NIMH) in
1989, found that for most people, two forms of psychothera-
py widely favored for depression, interpersonal therapy and
cognitive behavioral therapy, were no more effective than a
placebo plus a few visits to a primary care doctor.
As we saw
in the last chapter, primary care docs are not particularly ef-
fective in treating depression, so matching their results is no
One measure of psychotherapy’s ineffectiveness is the
disconcertingly large number of psychotherapists, starting
who have failed to overcome their own depres-
sion. Richard O’Connor, a psychotherapist who’s among the
most highly respected experts on depression, says most of
the psychotherapists he knows are on antidepressants.
acknowledges that he himself continues to undergo both
drug and talk therapy for depression, in spite of which he still
suffers episodes from time to time.
UP W ¡ T H O U T ME D S 66
Why depression is resistant to psychotherapy
I know of three facts that explain why psychotherapy doesn’t
First, negative thoughts feed depression, but depression
doesn’t start with them. As I discussed in Chapter 3, depres-
sion is a collapse of homeostasis. What makes the system
susceptible to collapse isn’t cognition, but genetic and child-
hood factors, on top of which we pile damaging lifestyle hab-
its—inadequate exercise, sleep deprivation, nutritional reck-
lessness, social isolation, and addiction. Since thoughts are
symptoms rather than causes, hoping to prevent depression
by changing them, the objective of psychotherapy, is like ex-
pecting to put out a forest fre by attacking the smoke.
Second, even if it were possible to end depression by
changing thoughts, how much control do any of us have over
what we’re thinking, even with a professional at our side? If
you’ve ever tried to meditate, you know that your mind, like
everyone else’s, is anarchy in its most obdurate form. You
don’t boss your mind around. It can’t even boss itself. The
most you can ever do is try to get it to do useful work.
Third, even if it were possible to end depression by chang-
ing your thoughts, how do you fnd the right person to help
you do it? Studies show there are no reliable criteria for choos-
ing a therapist.
The journal Psychological Science says, “The
outcome of therapy is not enhanced by [the therapist’s] train-
ing, education, or years of experience.”
In fact, according to
Consumer Reports, the average psychiatrist can’t help you
any more than the average social worker or support group.
One problem is that, because psychotherapy is an inti-
mate collaboration between two people, not unlike marriage,
the ft has to be right, and when you walk into a therapist’s
offce the frst time, it’s pretty much a blind date. As the New
YO U C A N ’ T T A ¡ K YO U R WA Y O U T 6;
York Times notes, “...a gifted therapist can leave a patient
cold. Like the tango, psychotherapy takes two....”
you know beforehand that you’ll be good dance partners?
Most blind dates don’t lead to marriage, and most people
don’t stay in psychotherapy long, either. In Consumer Re-
ports’ landmark study of four thousand readers who visited
a psychotherapist, about a third quit after the frst or second
visit. Another third were gone before their tenth visit. Only
10 percent made it through more than twenty sessions. And
even most of these stalwarts didn’t stay in therapy for a full
Which psychotherapist kept your
grandmother from getting depressed?
The main reason people who are suffering from depression
don’t stay in therapy long is that they soon fnd it doesn’t
put an end to their suffering. But why should we expect it
to? If psychotherapy were the answer for depression, our
grandparents and great-grandparents would have been in
big trouble, because how many therapists were around back
Mexico, where there are fewer licensed psychothera-
pists than there are in Connecticut, would be teeming with
emotionally tormented people, too, instead of enjoying half
the U.S. rate of depression.
And the Amish, who as a group
don’t make enough therapy appointments to keep a single
M.D. employed, would be the most depressed of all. Instead,
they’re virtually depression-free.
This is not to say that psychotherapy can’t be helpful. Fif-
ty minutes with an empathetic professional can be an impor-
tant form of meaningful social contact, one of the require-
ments for ending depression. In addition, psychotherapy can
help you lower the stress that triggers depression.
UP W ¡ T H O U T ME D S 68
What’s more, a good therapist is always happy to support
you in making decisions that will improve your life. Generally,
people who choose to practice psychotherapy do so because
they have a passion for relieving people’s suffering. Most
psychotherapists have an intuitive sense about what will help
people become happier, and they like nothing more than sup-
porting a client in doing what’s best for herself. When your
therapist hears that you’re going to start getting the exercise,
the sleep, the nutrition, and the social contact you need, and
that you’re going to drop your most depressing addictions,
you’re likely to receive a positive response.
I’ve described the success I had in ending my own de-
pression and the approach that grew out of it to quite a few
psychotherapists, and without exception, they’ve been en-
thusiastic. More than one has said he was going to adapt the
approach for his own clients.
Getting back to Freud, what would you recommend, based
on what you’ve read here so far, to help him overcome his
depression? Here’s the advice I’d offer:
Dr. Freud, you spend too much time sitting on your
chair and lost in your thoughts. Get out of the offce
and ride your bike through some of Vienna’s beau-
tiful bike paths for thirty minutes every day.
After dinner, slow down that overactive mind so it
doesn’t keep you up half the night. Stop writing by
7 p.m. Relax for the next two hours. Maybe do some
meditation. Then turn in by 9 to get a full night’s
YO U C A N ’ T T A ¡ K YO U R WA Y O U T 6¤
Cut back on all that Viennese comfort food, the
wiener schnitzel, pomme frites, Sachertorte, choc-
olate, and coffee. Start eating more fsh, whole
grains, and fresh vegetables and fruits.
Spend less time thinking and writing and more
time enjoying your fascinating circle of friends. Re-
sist your tendency to hole up by yourself. You wrote
your colleague Ferenczi: “I tell you, it was often
more agreeable [when] I was alone.” Yes, it may be
more agreeable in the short run, but for you, it’s a
sure path to depression.
A cigar may be just a cigar, as you say, but it’s feed-
ing your depression. Try chewing gum instead, if
it’s been invented yet. Oh, and get off the cocaine.
Would Freud have taken this advice? I doubt it. Like a lot of
intellectuals, he believed that the mind is where the fullness
of life happens, and that the four-ffths of a person located
below the neck is, to borrow Sir Ken Robinson’s quip about
university faculty, just there to get the head from one place
to another. This distorted point of view had a lot to do with
keeping Freud depressed, because it prevented him from see-
ing that many of his problems, though they found their way
into his mind, originated in his heedless lifestyle.
One famous intellectual who succeeded in overcoming
his depression to a signifcant degree was Robert Burton, a
seventeenth-century Oxford scholar and cleric. Burton was
known for his cheerfulness and love of a good time, but he
sometimes fell into deep depressions. A man of exquisite
self-awareness, he understood that his recurrent low moods
were a kind of illness, and he took a great interest in his own
symptoms, their causes, and the possibility of a cure. He pub-
UP W ¡ T H O U T ME D S ;o
lished his insights in The Anatomy of Melancholia, a massive
treatise that is still valued as a cornerstone of scholarship on
Burton was among the frst to see that depression has
multiple underlying causes. He cited, among other things,
heredity, bad childhood experiences, poor diet, overwork,
stress, addiction, social isolation, and lack of exercise. Ob-
serving himself and his moods closely, he found that when
he made changes in his habits, like taking up regular exer-
cise and spending more time with his friends, his mood im-
proved. Using this knowledge, he was able not only to reduce
the number and severity of his episodes, but found he could
even pull himself out of depression after an episode started.
(You can, too. See Chapter 12.)
Almost four hundred years ago, Robert Burton under-
stood what many people today have forgotten: You can’t think
your way out of depression, because you didn’t think your
way in. When you’re depressed, it’s not because of the way
your mind works, but because of the way your life doesn’t
work. Make a few changes in the way you live—are you listen-
ing, Sigmund?—and your depression ends.
If you’d like additional help in making some of the chang-
es that Robert Burton found effective in treating his own de-
pression, there’s live, personal guidance and support avail-
able at 5decisions.com.
S I X
us e i t ( yo u r bo D y )
or L o s e i t ( yo u r mi n D)
A s s u r e l y a s a s h a r k t h a t s t o p s
s w i mmi n g s u f f o c a t e s , a d e p r e s s i v e
wh o s t o p s mo v i n g g e t s d e p r e s s e d .
epression is common among elite athletes who are
sidelined with an injury or have to retire, and we ex-
plain this by saying it’s because they can no longer
do what they love to do, or because fame, glory, and product
endorsement deals are now out of their reach. And we’re not
altogether wrong. These losses often do trigger depression.
But a setback that sinks someone’s mood is never what holds
them under. (Remember, the iceberg made the Titanic go
down, but it doesn’t play any role in keeping the ship on the
bottom.) The things that most likely traps a sidelined athlete
in depression? It isn’t a career disappointment. The problem
is that he’s stopped exercising.
In 2007 a research team at the University of Michigan
studying depression among retired National Football League
players found that the biggest difference between those who
were depressed and those who weren’t was that the depressed
players had given up exercise.
Kevin Guskiewicz, director of
the Center for the Study of Retired Athletes at the University
of North Carolina, found a similar connection when he sur-
veyed twenty-seven hundred retired football players. He told
the New York Times, “What happens is that the retired ath-
lete can’t exercise because of the injuries he’s sustained and
pain he is in, and that leads to higher weight, depression, bad
eating habits, high blood pressure, and so on.
UP W ¡ T H O U T ME D S ;z
But are so many retired athletes depressed because they
aren’t exercising—or have they stopped exercising because
they’re depressed? The answer is “yes” to both questions. It
works both ways. Vicious circles always do.
Depression has an immobilizing effect on its victims,
but most people suffering from it were quite inactive before
they got depressed. Of course, this isn’t unique to depres-
sives. About half of all Americans are now dedicated couch
potatoes (or the new potato variety created by the personal
computer, mouse potatoes). With each decade since the Sec-
ond World War, more and more of us have become sedentary.
One-fourth don’t get enough exercise to maintain physical
and emotional health. Another 25 percent don’t get any ex-
ercise at all.
Technology analyst Paul Saffo told USA Today,
“I suspect the only exercise Americans are getting is walking
between their TVs and their computers.”
Just a few decades ago, most jobs, including the job of grow-
ing up, involved heavy or moderate exercise. Now, chances
are, you earn your livelihood without lifting a fnger, or per-
haps, like me, by moving just ten fngers and sometimes your
mouth. And if you have a typical American job, you’re at your
desk longer, and sitting in you car longer on the way to that
desk, than people ever have been, or the average worker any-
where else in the world is even now.
When you get home, you may be on your feet only brief-
ly, before you sit down to dinner, and then afterwards settle
down in front of a fickering screen. If you’re a typical Ameri-
can, you watch, each day, an average of three hours of TV
spend almost an hour and a half online.
In all, over half of
your waking hours, if you’re typical, are occupied with some
form of media, when you’re sitting or lying down.
US E ¡ T O R ¡ O S E ¡ T ;¤
A study at the University of California, Berkeley, found
that Americans are now spending most of their leisure time
in front of the TV—nine times as many hours watching shows
as playing a sport, exercising, or enjoying some other active
Teens and young adults spend almost all their
free time, a full eight hours a day on average, sitting or lying
down while they surf the Web, watch TV, listen to the radio,
play video games, talk on the phone, or read books and mag-
Children under six now sit in front of a television or
computer screen more than they play outside.
A few generations ago, the average American walked three
miles a day,
including the walk to work and back. Now it’s
down to a quarter-mile.
Putting exercise back in your life
Exercise is so important that, even if other aspects of your
lifestyle aren’t depressive, too little exercise can be all it takes
to bring you down. But if you start exercising on a regular
basis now, the negative effects of a sedentary lifestyle will
start to correct themselves, and your emotional buoyancy
will begin building almost immediately. If you’re willing to
keep at it, exercise will provide more protection against de-
pression than any medication, any psychotherapy, any new
way of thinking, any assertiveness training, or any medita-
Exercise benefts are proven by mainstream medicine
The curative power of exercise isn’t an oddball theory cham-
pioned by some alternative-lifestyle group. It’s been proven
in study after study, at some of the most highly regarded in-
stitutions in the U.S., including the Mayo Clinic,
UP W ¡ T H O U T ME D S ;q
and the University of Texas.
have been reported in publications like the Journal of the
American Medical Association,
the New England Journal
the New York Times,
the Washington Post,
and the Wall Street Journal.
According to a 1999 Duke study, even a modest amount
of exercise not only relieves the immediate symptoms of de-
pression as well as Zoloft, the leading antidepressant medi-
cation, but offers fve times better protection against future
In a study at the University of Texas, people who added
just thirty minutes of exercise three days a week reduced
their depression symptoms by 50 percent. Those who exer-
cised harder, longer, or more frequently reduced their symp-
toms even more. And for most people the benefts lasted.
An Atlanta psychiatrist, Sheldon B. Cohen, found that his
own mood improved so much when he went running, he be-
gan using exercise therapeutically with his patients, and now
asks them to accompany him on a walk or run while he con-
ducts the session.
He’s 78 years old, by the way.
Doctors at McLean Hospital in Belmont, Mass., argu-
ably the premier mental health facility in the U.S., were so
impressed by recent studies showing that exercise relieves
the symptoms of schizophrenia, they added a weight room
for treating this most intransigent of disorders, and have
achieved marvelous results with it.
If exercise can effective-
ly treat madness, imagine what it can do for depression.
So why do you hear so little about exercise and so much
about Prozac, Zoloft, and Paxil? It’s because big companies
haven’t fgured out how to make billions a year selling exer-
cise, so there’s no advertising or publicity budget for it. Exer-
cise doesn’t have a sales force, either.
US E ¡ T O R ¡ O S E ¡ T ;=
Better than an apple a day
Put aside for a moment the power of exercise to build buoy-
ancy. The list of other health and safety benefts goes on and
on. Exercise builds strength,
It lowers the risk of physi-
of other diseases.
It prevents frailty in old people.
gates the symptoms of most serious illnesses, including os-
It helps people lose weight,
and helps them
look younger and more attractive.
New research shows
that it even makes people, no matter how young or how old,
As for depression, a program of regular exercise fghts it
on—count them—eleven fronts:
Flushes out the stress hormone cortisol, a key
chemical driver of depression
Washes out the depressive toxicity of alcohol and
other harmful substances
Floods the bloodstream with serotonin and the
other hormones of happiness
Increases blood fow and oxygen to the brain, im-
proving cognition and mood
Stimulates the growth of new brain cells and in-
creases the size of the frontal lobes, reversing the
negative neurological effects of depression
Decreases tension and increases energy
Aids you in getting more and better sleep
UP W ¡ T H O U T ME D S ;6
Connects you with Nature when you exercise out-
doors, and connects you with other people when
you exercise with a partner or group
Improves your physical wellbeing and appearance,
and thus your self-esteem
Helps you recover from addictions
Enhances your sense of control and accomplish-
ment, improving how you think about yourself
All exercise is good
Research suggests it doesn’t matter what type of exercise you
do, as long as it’s moderately strenuous and you do it on a reg-
Walking, running, biking, swimming, dancing,
yoga, martial arts, rowing, skating, strength training—any-
thing that increases your heart rate or works your muscles
for a period of thirty or forty minutes will strengthen your
mood recovery system. Even a vigorous game of table tennis
has been shown to produce excellent results.
You can concentrate on just one form of exercise, or vary
what you do. For buoyancy purposes, it doesn’t matter. The
important thing is that whatever you decide to do, whether
it’s just one form of exercise or decathlon training, you keep
doing it at least three times a week, week after week. Keep at
it. Don’t stop. The reason Nike’s slogan—Just do it—hooked
everybody right away is that in our hearts we all know it re-
ally is as simple as that.
What will work best for you?
Let’s talk about setting up an exercise program for you—one
that you’ll stick with.
US E ¡ T O R ¡ O S E ¡ T ;;
Don’t try to be spontaneous about exercise. Put yourself on a
schedule. The easiest way to do this is to join a class or pro-
gram, or become a member of a team.
If you decide to exercise on your own rather than joining
a formal program or team, structure it as if it were a formal
program. Schedule your exercise at the same time and on the
same days each week. Put the schedule in writing. Have a
Plan B ready if you need to miss a session. For example: “If I
have to go to lunch with a client and can’t take my usual walk
at noon, I’ll walk after I get home from work.”
Go public with it
One of the most powerful human motivators—it’s so potent
that army generals count on it to induce soldiers to put their
lives on the line
—is social pressure, or the avoidance of
shame. Smart people use it as a way to motivate themselves
to keep their commitments.
So don’t be private about your exercise program. Tell peo-
ple about it. Put yourself on the hook by giving them details.
Be specifc. Don’t tell them, “I plan to going to start running
next week.” That provides too much wiggle room. Instead,
make a real commitment. Say, for example, “I’m going to run
fve miles, three times a week for the next six weeks.” That
removes the wiggle room, and puts you on the hook for a long
enough time to embed the habit.
Let your friends know they’re an important part of your
program. For example, tell them: “I’d appreciate it if, now and
then, you’d ask me how I’m doing. That’ll help me stick with
UP W ¡ T H O U T ME D S ;8
If you need additional support, it’s always available at
Do what you enjoy
Since all forms of exercise are effective against depression,
the most important thing is to choose those that you’ll be
most likely to keep doing. If you enjoy it, you’ll keep doing it.
But you need to balance this consideration against another
factor: It’s important to avoid making choices that might sab-
otage your program. For example, if basketball is what you
enjoy most, but you can’t count on the other players to show
up every week, you’re better off choosing something that
doesn’t have the possibility of failure built into it.
Give yourself time to start loving it
When my friend Jamie urged me to join a health club, I re-
sisted, because, I said, every time I ever tried working out on
machines or free weights, I hated the discomfort. “That’s be-
cause you always gave it up too soon,” he said. “It feels bad at
frst because you’re so out of shape. Put up with feeling lousy
for a few sessions, and you’ll reach a point where the workout
starts feeling good. You’ll start looking forward to getting on
the machines.” He was right.
In addition to discomfort, you may have some psychologi-
cal resistance at the beginning. Habits, including the habit of
not exercising, take time to reverse. Just hang in there un-
til the lethargy habit is gone and the exercise habit is estab-
lished. After that, it won’t seem like such a chore.
If you can stick with it for just six months, research shows
that your chances of continuing long-term are good, because
it gives the habit enough time to embed itself in your life, and
US E ¡ T O R ¡ O S E ¡ T ;¤
enough time for the benefts to start showing up to provide
At the beginning, watch out for exuberance and unrealistic
expectations, especially if it’s been some time since you ex-
ercised vigorously. It’s natural to forget you’re no longer the
sixteen-year-old who could leap tall buildings, at least until
you fnd yourself limping around the house. But if you over-
do it, you may sideline yourself with an injury, and then you
may not be able to exercise at all for a while. It’s best to treat
yourself like a delicate piece of porcelain until you know what
your limits are. Start out doing less than you think you’re
capable of, and build slowly. To be safe, consult a coach or
Build toward greater intensity, duration, and frequency
Within reasonable limits, the harder, longer, or more fre-
quently you exercise, the better. In a 2006 Duke study of
middle-aged people, a little mild exercise repeated over a pe-
riod of two months reduced the chances of a heart attack by 8
percent; more vigorous exercise over a longer period reduced
the chances of a heart attack by 24 percent.
Using the rule
of thumb that what’s good for the circulatory system is good
for buoyancy, it would appear that more exercise equals less
depression. So when you’re ready, try upping the ante. But
Pay attention to your subjective experience
When you exercise, you may not pay much attention to how
you’re feeling, unless you feel bad. In competition, it’s natural
to put all your attention on winning, and ignore your sub-
UP W ¡ T H O U T ME D S 8o
jective experience. When you’re training, you may focus on
getting the form or the timing right, or perhaps just think
about how much you wish the session were over. When the
exercise is something simple and repetitive like walking, it’s
easy to let your mind wander. But one way to reward yourself
for exercising is to change your focus and notice how great it
makes your body feel as you’re doing it.
My wife Judy, who has been doing resistance training for
several years, said she just started to notice how each repeti-
tion warms her muscles in small but noticeable increments.
Experiencing her body gradually warming up all over, she
says, adds to her enjoyment and helps motivate her to keep
Get into the habit of making a note of your mood before,
during, and after your workout. When you see the difference
exercise makes in how you think and feel, it’ll increase your
motivation to keep doing it.
Gild the lily
If your exercise is something that doesn’t require full at-
tention, you can make it more enjoyable by exercising in a
beautiful setting, listening to music or an audiobook, exer-
cising with other people, doing mind puzzles, meditating, or
Set positive goals
You can’t train a dog to roll over by punishing him when he
refuses. You have to give him a treat when he obeys. Similarly,
if you’re exercising only to avoid something negative, whether
it’s depression or physical illness, what’s missing is positive
reinforcement that makes you want to do it next time. (An
exception: when exercise is part of the routine you use to pull
US E ¡ T O R ¡ O S E ¡ T 81
yourself out of an episode that has already started, the rein-
forcement is positive and it’s dramatic. We’ll talk about this
in Chapter 12.)
One of the most effective ways to reward yourself is to set
goals and meet them. The right goals for you depend on your
personality, your stage of life, and the type of exercise you’re
doing. Here are some possibilities:
If you’re playing a competitive sport, set a series of
escalating competitive goals, like: “I’ll start
winning one set out of three against Joyce. Then
I’ll start beating her. Then I’ll make it to the third
round of the tournament. Then….”
If there is an aspect of your performance that’s
measurable, set a performance goal, even if it
seems arbitrary and relatively unimportant. Some-
times I push myself to do my three-mile walk in
thirty-fve minutes just to keep myself interested.
Set physical-improvement goals. Keep a log
showing progress in any metric that applies, like
heart rate recovery, muscle strength, increased en-
durance, distance covered, decreased body fat, in-
creased energy, weight loss, or compliments from
Anticipate problems. No matter how committed
you are to your exercise program, you can be sure
that sooner or later, something will come along that
gets in the way. Before you begin, think about pos-
sible obstacles. Plan what you’ll do if you encounter
them, and commit to the plan. That way, if a prob-
lem does come up at a time when your motivation
UP W ¡ T H O U T ME D S 8z
is low, you’ll be more likely to make the adjustment
that protects your commitment. For example:
Plan alternative activities in case you get injured
or sore, or lose interest in the exercise you’ve
Think about how you’ll shift your exercise to an-
other time or day if something comes up that in-
terferes with your regular exercise schedule.
If your activity depends on weather, have an al-
ternative ready for when the weather doesn’t co-
If your activity depends on other people—a per-
sonal coach, tennis partner, or teammates—an-
ticipate what you’ll do for alternative exercise if
they have to cancel.
Give walking some serious consideration.
A commercial for walking
Just a few generations ago, most people who had the predis-
position for depression that you and I share made it through
life without a single episode. One reason was that they walked
everywhere. And now, in the technologically advanced
twenty-frst century, it’s still hard to beat walking as an an-
tidepressive. That may be why, when the Harvard Medical
School faculty were surveyed, they said walking was their ex-
ercise of choice.
Here are some of the reasons walking is a great way to
US E ¡ T O R ¡ O S E ¡ T 8¤
It’s been heavily researched and proven effective
It provides three types of exercise—aerobic, stretch-
ing, and strengthening.
It offers a good range of intensity, from very low
(regular breathing) to moderately high (diffcult to
carry on a conversation). This means you can tailor
it to your conditioning level, and increase the inten-
sity as your conditioning improves.
When you walk on hilly terrain, you get two sepa-
rate cardiovascular benefts: Uphill lowers triglyc-
erides. Downhill lowers blood sugar.
You can do it anywhere—even in an airport be-
You don’t have to shower afterwards.
It requires no signing up for anything, no transpor-
tation to somewhere else, no special equipment, no
coach, no teammates, and no suiting up.
It gets you out of the house.
It’s easily available as a makeup workout if you have
to skip another form of exercise that you normally
It costs nothing.
You’re already good at it.
If you have to reschedule, it’s easy.
If the weather is wretched, you have the mall, the
stairs, or the treadmill.
UP W ¡ T H O U T ME D S 8q
You can make it more interesting by varying your
It’s the form of exercise that’s least likely to cause
It’s something you can do with your favorite people,
since they’re good at it too.
You can enhance it with music, Nature, audiobooks,
problem-solving, meditation, gratitude practice, af-
frmations, or great conversations.
It can evolve into other enjoyable, antidepressive
activities, including hiking, backpacking, snow-
shoeing, and jogging.
It’s the very best way to see the world.
If you allow just one chapter of this book to make a differ-
ence in your life, I hope it will be this one, because exercise
can do more to protect you against depression and improve
your life in general than anything else. If you aren’t already
exercising three times a week, every week, I hope you’ll start
now. If you are already exercising, I hope what I’ve been say-
ing will help persuade you to keep it up for the rest of your
life. Nothing—but nothing—is more important to your health
S E V E N
es C A P i n g f r o m
s L e e P - D e b t o r ’ s P r i s o n
Mo s t A me r i c a n s a r e i n t h e d a r k a b o u t t h e i r s l e e p
p r o b l e ms . T h i s p r o b a b l y i n c l u d e s y o u .
hundred forty years ago England stopped jailing
people who couldn’t pay their debts, but there’s a
prison still open for people who don’t pay the Sand
Man what’s owed him, and it’s flling up fast. This dungeon
can be almost as bad a place to be stuck in as institutions like
Marshalsea Prison, where Charles Dickens’ father John was
confned for his debts. It’s the prison of depression.
Though some people sleep more when they’re depressed,
four out of fve lose sleep during an episode.
But most people
who are depressed were sleep deprived before the depression
hit. It was the sleep defcit that helped bring on their depres-
Of course, it isn’t just depression-prone people who aren’t
getting enough sleep. The National Sleep Foundation says
that a majority of Americans are now having problems at
For those like you and me whose genes and childhood
make us susceptible, undersleeping is a sure road to depres-
For those who aren’t depression-prone, sleep problems
lead to a host of other physical and psychological maladies—
none of which we depressives are immune to, either.
not getting enough sleep, depression may be only the most
visible part of the damage you’re doing to yourself.
You may be among the sleep-deprived majority and not
even know it. Most of America’s sleepy heads are in denial
UP W ¡ T H O U T ME D S 86
about their condition.
They haven’t a clue that a lack of sleep
is impairing their physical health, eroding their emotional
wellbeing, and threatening the safety and happiness of the
people around them. Like a drunk who believes he’s ft to drive
after fve vodkas, they think they’re fne. But they aren’t, any
more than the drunk is. They’re kidding themselves about
how much sleep they need, and blind to what happens when
they don’t get it. According to a study by Thomas Roth, direc-
tor of the Henry Ford Sleep Disorders Center at the Henry
Ford Hospital in Detroit, you can even be “pathologically
drowsy” and still think you’re fne. The study showed that
some people who test as sleepy as narcoleptics—so groggy
they suddenly nod off in the middle of a conversation—aren’t
even aware that they’ve got a problem.
One reason you may not be the best judge of how much
sleep you need: If you’re constantly sleep deprived, you don’t
have anything to compare it with. Just as people born with
poor vision or dyslexia don’t understand they’re seeing things
differently from everyone else until they’re tested, you may
think your substandard experience of life is normal.
Even if you’re aware that you don’t feel great, you may not
catch on that it’s connected to your poor sleep habits. Dracu-
la’s victim Lucy fails to realize something is happening to her
at night that is progressively weakening her. Similarly, you
may be in the dark about what’s not happening every night
that’s causing your problems.
A shock to your great-grandmother
If our ancestors could see how little we’re sleeping, they’d be
amazed. As recently as a hundred years ago Americans were
getting a full nine hours,
and it wasn’t because people back
then were too lazy to get out of bed, or because they had so
little work to do that they could afford to lie around an extra
O U T O ¡ S ¡ E E P - D E B T O R ’ S P R ¡ S O N 8;
hour or two. They were sleeping those extra hours because
that’s how much sleep they needed.
Could it be that for some reason we moderns need less
sleep? There is no evidence for it. All the studies addressing
this question conclude that we require the same amount of
sleep as our ancestors did, just as today our oxygen needs are
the same as theirs.
There have been no changes in our physi-
ology or any shift in circumstances that could have reduced
our need for sleep. It’s just that now we’re disregarding this
fundamental requirement on a massive scale.
The mythical night owl
Most of today’s sleep experts agree that the average minimum
we need every night is eight hours.
This doesn’t mean that
some people need six and others ten. Recent research shows
that sleep requirements vary less than you might think, with
most adults even at the low end of the scale needing a full
Children, teenagers, and young adult males
need even more.
The sleep gap isn’t closing. Just as the average American
vacation shrinks a little each year, the average night’s rest
gets shorter and shorter. In 2001, 38 percent of all adults in
the U.S. said they were sleeping less than they were just fve
The survey noted that most of them didn’t see
this as a serious problem.
Our delusions about how little sleep we can get away with
are reinforced by the currently popular idea that sleep is for
sissies. Bill Clinton, Jay Leno, and Martha Stewart are among
those who have helped make four or fve hours of sleep fash-
ionably macho, and encouraged people to believe that skimp-
ing on sleep is an effective success strategy. But it isn’t. Bill
Clinton has said he made the worst mistakes of his Presiden-
cy when he was under-rested.
When he stayed up half the
UP W ¡ T H O U T ME D S 88
night weighing policy alternatives or playing his favorite card
game, hearts, we all paid the price.
And it’s a good thing he wasn’t running a forklift in the
Oval Offce. Studies show that even a small sleep defcit ham-
pers alertness, reaction time, and learning ability—and not
just for some people, but for everyone.
Going to work when
you’re behind on sleep quadruples your chances of a work
and, according to the Highway Traffc Safety Admin-
istration (NHTSA), multiplies your chances of getting into a
The National Sleep Foundation’s 2005 survey
turned up the disquieting fact that one in ten Americans say
they’re falling asleep at the wheel at least once a month.
paired judgment attributed to sleepiness was cited in offcial
reports as a cause of the Chernobyl,
Three Mile Island,
and Challenger disasters.
A 2006 Harvard
Medical School study found that severely sleep-deprived doc-
tors make seven times as many mistakes as well-rested docs,
including three times as many fatal mistakes.
Skimping on airplane maintenance
Not long ago, people thought that sleep was just the body and
mind shutting down, but we now know that a host of mainte-
nance operations that are essential to our health are going on
while we slumber.
When these nightly tasks don’t have time
to be completed, trouble ensues. Shorting yourself on sleep
is a little like taking off in a plane before the mechanics have
fnished going over it.
Eve Van Cauter, a professor of medicine at the Univer-
sity of Chicago, told the Washington Post, “Lack of sleep dis-
rupts every physiologic function in the body. We have noth-
ing in our biology that allows us to adapt to this....”
the disruption is repeated night after night and month after
month, it weakens the body’s ability to fght off disease, and
O U T O ¡ S ¡ E E P - D E B T O R ’ S P R ¡ S O N 8¤
potentially subtracts years from your life. A long-term pat-
tern of sleep deprivation has been shown to increase the risk
of high blood pressure,
One way sleep deprivation shortens lives, of course, is by
causing depression, a key risk factor for early death by both
If you track the depression epidemic as it has spread
across the U.S. during the last hundred years, you fnd that
it has run approximately parallel to the sleep-deprivation
curve. In 1975, Americans were getting an hour more sleep
than we are today,
and depression wasn’t anything like the
problem it is now.
In 1910, when people were averaging two
hours’ more sleep,
depression was rare.
A gender difference
One of the many reasons women suffer more depression
than men is that more women are sleep deprived. When the
National Sleep Foundation identifed the segment of the U.S.
population with the worst sleep problems, they found that
three-fourths of this poorly-rested group were women.
About twice as many suffer from insomnia as men.
than half say they get, at best, no more than a few good nights
of sleep each week.
Depression is much more prevalent in young people than
it was just a few years ago,
and one reason is that almost
half of today’s children and teenagers have sleep problems.
According to a Sleep Foundation survey, 60 percent of chil-
dren ages 4 to 17 complain of feeling tired during the day.
On average, American teenagers get an hour and a half less
sleep than they need.
According to conventional wisdom, sleep needs diminish
in old age, but studies show that an 80-year-old needs just
UP W ¡ T H O U T ME D S ¤o
as much sleep as she did when she was 40.
standing about this may stem from the fact that many older
people do need less sleep at night, but this is only because
they nap during the day,
not because their overall need for
sleep is different from anyone else’s.
People caring for a dying spouse or parent suffer a greater
rate of depression than almost any other group.
sity of Texas study found that the chief factor isn’t, as you
might think, overwork, sadness, or anxiety about losing their
loved one. It’s sleep deprivation.
A little sleep loss can be all it takes
Michael Perlis, associate professor of psychiatry and psychol-
ogy at the University of Rochester, calls sleep problems the
“unleashing factor” for the disorder. A regular pattern of in-
somnia, his research shows, multiplies the risk of both a frst
episode and successive episodes, and lengthens the time it
takes to recover after depression moves in.
A 2001 National Science Foundation survey found that
sleep deprivation was a factor in 83 percent of depression
Can sleep deprivation be a cure?
Recent studies have led some people to believe that clinical-
ly induced, short-term sleep deprivation can be an effective
treatment for depression,
but the latest research indicates
that the benefts are temporary and ultimately self-defeating,
with the loss of sleep driving people into a deeper depression
after some initial improvement.
O U T O ¡ S ¡ E E P - D E B T O R ’ S P R ¡ S O N ¤1
Sleep deprivation has a variety of causes. Let’s see what
might underlie the problem in your case, and talk about how
you can make adjustments so you’ll get the sleep you need for
Television and Internet
How many nights a week do you stay up late watching tele-
vision or surfng the Web? For American adults, TV is now
the third-ranking way to spend time, after work and sleep, at
three hours per day for adults.
Web surfng among adults is
at one-and-a-quarter hours per day and rising.
people, the numbers are even higher.
The solution? Train
yourself to turn it off and go to bed.
About one in eight Americans suffers from insomnia,
many of these troubled sleepers are depressed.
If you’re an
insomniac, you can try changing your habits and see if that
solves the problem. If not, professional help is available.
Here are ten tips from the National Sleep Foundation that
have proved effective:
Maintain a regular bed and wake time schedule
Establish a regular, relaxing bedtime routine such
as soaking in a hot bath or hot tub and then read-
ing a book or listening to soothing music.
Create a sleep-conducive environment that is
dark, quiet, comfortable and cool.
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Sleep on a comfortable mattress and pillows.
Use your bedroom only for sleep and sex.
Finish eating at least 2-3 hours before your regu-
Exercise regularly. It is best to complete your
workout at least a few hours before bedtime.
Avoid caffeine (e.g. coffee, tea, soft drinks, choco-
late) close to bedtime. It can keep you awake.
Avoid nicotine (e.g. cigarettes, tobacco products).
Used close to bedtime, it can lead to poor sleep.
Avoid alcohol close to bedtime.
© 2006 National Sleep Foundation
This condition, which affects eighteen million American
and possibly an even larger percentage of children,
repeatedly stops your breathing for a few seconds at a time
while you’re sleeping. It seriously compromises the quality of
rest, resulting in sleep deprivation even when you’re sleeping
an adequate number of hours.
Sleep apnea has been linked to heart problems
cause it leaves people sleep deprived, is also a factor in de-
The cause may be any of a number of slight physiological
abnormalities, including a small upper airway or large uvula.
Common symptoms are heavy snoring, drowsiness during
the day even after eight or nine hours of sleep, and, as I men-
O U T O ¡ S ¡ E E P - D E B T O R ’ S P R ¡ S O N ¤¤
Like those who are sleep deprived for other reasons, most
people who suffer from sleep apnea aren’t aware of the prob-
If you suspect you might have it, see a doctor, and have
her arrange an overnight stay for you in a sleep center, where
they’ll monitor your sleep for a full night and give you a diag-
nosis. For a list of sleep centers in your state accredited by the
American Academy of Sleep Medicine, go to:
There are several effective treatments for apnea, including
a face mask that channels air to the air pathway, and minor
Disrupted sleep cycles
If you’re one of the fve million Americans who work when
most people are sleeping,
you face special challenges in get-
ting a good night’s rest. No matter how long you keep work-
ing a night shift, your biological clock remains tied to cycles
of daylight and darkness, and your body never fully buys into
the idea of sleeping during the day. If you change shifts peri-
odically, or you alternate day-sleeping during the week with
night-sleeping on weekends, your body gets even more con-
Because of this interference with circadian rhythms, shift
workers tend to have a harder time getting a full eight or nine
hours of sleep, and even when they do, it’s frequently not the
But there’s plenty you can do, short of
quitting your job, to improve your sleep. The National Sleep
Foundation provides a long page of advice for shift workers
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Pain and discomfort caused by infrmities, ailments, and the
medications prescribed for them can keep people awake and
reduce the quality of their sleep. In the National Sleep Foun-
dation’s 2003 national poll, two-thirds of older Americans
reported having sleep problems at least a few times a week,
and these problems were often tied to the physical symptoms
of arthritis, heartburn, asthma, heart disease, and other
problems that often accompany old age.
It’s one reason old-
er people are the most depressed of all age groups.
If physical problems are keeping you from getting a full
night’s sleep, there are three things you can do about it:
First, look for ways your behavior may be aggravating
your sleep problems. The American Sleep Foundation’s tips
listed under “Insomnia” above are a good place to start.
Second, if there are things you could do to reduce your
physical symptoms, consider doing them. Most diseases re-
spond, at least to some degree, to lifestyle changes—including
regular exercise and the other good habits that I recommend
for ending depression. Once you understand that your physi-
cal symptoms are contributing to your depression by depriv-
ing you of sleep, it may be all the motivation you need to make
the changes you know you should be making anyway.
Third, have a conversation with your doctor about any
prescription medications that might be causing sleep prob-
lems for you. If you and your doctor conclude that your sleep
might improve with different medications or alternatives to
medications like diet changes, they may be worth trying.
O U T O ¡ S ¡ E E P - D E B T O R ’ S P R ¡ S O N ¤=
Restless legs syndrome
RLS disrupts the sleep of millions of Americans every night.
If you have it, you don’t need to be told what it is: the irresist-
ible urge to move your legs when you’re lying in bed or sitting
down. The FDA has approved two drugs for RLS, Requip and
Mirapex. But the lifestyle changes covered in this book, espe-
cially exercise and avoidance of alcohol and other addictive
substances, often relieve RLS symptoms without drugs.
The website of the Restless Legs Syndrome Foundation:
The person in bed next to you
If your partner’s snoring, insomnia, or restless legs syndrome
is keeping you up, let him know there are good treatment op-
tions for all of these problems, and encourage him to explore
the possibilities. If he solves his problem, both of you will be
healthier and happier.
If the problem, or the partner, proves to be intransigent,
keep in mind that many couples share a bedroom for roman-
tic purposes, then retire to separate rooms for the solitary
task of sleeping.
Among the most vicious of circles in depression is the feed-
back loop in which sleep deprivation leads to depression,
which in turn leads to even more sleep problems. Depression
frequently encourages insomnia, restless sleep, and prema-
And when you’re depressed, you get less of the
deep sleep that provides rest and rehabilitation, and spend
up to twice as much time dreaming, which means that some
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of the required maintenance that sleep normally provides
doesn’t get done.
You may wake up feeling worse than you
did when you went to bed.
By exercising regularly, eating sensibly, and following the
other recommendations in this book to condition yourself
against depression, you’ll set up a virtuous circle that can
eventually improve your sleep patterns as well. If you’d like
some help getting things started in the right direction, you’ll
fnd live, personal guidance and support at 5decisions.com.
Like the other decisions that you make to end your de-
pression, the decision to start honoring your sleep needs not
only protects you against future episodes, but makes you a
healthier and happier person than you used to be even on the
days when you weren’t depressed. People who sleep longer
often live longer, and always live better.
E I G H T
r e n o u n C i n g
nu t r i t i o n A L r e C k L e s s n e s s
Fo r a d e p r e s s i v e , t h e mo s t d a n g e r o u s
p l a c e i n t o w n ma y b e t h e s u p e r ma r k e t .
ith depression doubling every twenty years in the
U.S., you’d think they were putting something in
They are. It’s called high-fructose corn syrup.
America’s other drinking problem
A Japanese scientist invented it, in 1971,
but no group has
embraced it as Americans have.
High-fructose corn syrup
produced the most dramatic dietary change in the history
of the United States, between 1970 and 1990, when our con-
sumption of HFCS, as it is known in the food industry, in-
creased by a multiple of ten.
During this same period, in a
closely related trend, our consumption of soft drinks bur-
geoned. Now, fully one-ffth the calories we consume in this
country are in the form of beverages, and sweetened bever-
ages, soft drinks above all, are our favorite way of getting two
hundred calories of high-fructose corn syrup into our bod-
ies every day, in addition to an equal amount of cane sugar
that we consume daily.
HFCS is the chief reason per-capita
U.S. sugar consumption is up 25 percent just since the se-
nior George Bush was president,
and up twenty-seven times
since my grandparents were born.
Today, thanks in large part to the innocuous-seeming
corn plant, the average American is running far more sugar
through her system than the human body is built to handle
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safely. If you’re susceptible to depression, it’s a pretty good
bet you’re trying to boost your energy and mood by consum-
ing even more sugar than that.
In addition to soft drinks, high-fructose corn syrup is in
cookies, cakes, bread, breakfast cereals, packaged fruit juic-
es, crackers, soup, mayonnaise, ketchup, frozen foods, salad
dressings, yogurt, peanut butter, jams, and most other pro-
cessed foods you can name, even bacon.
Not Nature’s own
What could be wrong with something as wholesome-sound-
ing as fruit sugar (fructose) that comes from something as
evocative of the heartland as corn? Well, to begin with, corn
is not a fruit, and so, as you might guess, there is no fruit
sugar in it. Corn is forced to yield large amounts of sugar only
through the technological alchemy of a complex industrial
process. Centrifuges, fltration chambers, enzyme slurries,
and ion-exchange columns—a layman could mistake it all for
a uranium-enrichment operation—are used to digest corn
starch so it becomes glucose, and then to digest the glucose
in turn, converting it to fructose. For soft drinks, 90-per-
cent-pure fructose from corn, created in the second round of
digestion, is mixed with 100-percent glucose from corn, cre-
ated in the frst round, to approximate the half-and-half ratio
of fructose and glucose found in cane sugar.
Food processing companies and fast-food outfts fnd a lot
to like about HFCS, beginning with its price; it delivers equal
calories and sweetness more cheaply than cane sugar—but
not because it’s less expensive to produce. On the contrary, if
it weren’t for big favors handed out to its powerful boosters,
corn syrup wouldn’t come close to being price-competitive
with cane sugar. But Federal law steeply tilts the playing feld
in its favor by giving four billion dollars a year in subsidies to
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subsidies whose main impact is to help Ameri-
cans purchase calories that are injurious to their health. Be-
tween 1985 and 2000, the price of soft drinks dropped al-
most 25 percent in real terms
at the same time the price of
fruits and vegetables rose nearly 40 percent.
As if the government handout weren’t enough, Washing-
ton makes corn syrup even more attractive to companies by
placing tariffs and quotas on imported cane sugar that arti-
fcially jack up its price two to three times beyond the world-
HFCS is as much a product of the U.S. gov-
ernment and its policies as of Archer Daniels Midland, the
biggest syrup producer and, as you might guess, a major con-
tributor to both political parties.
HFCS has other commercially desirable attributes, be-
sides low cost. Because it is an industrial product, producers
who mix it into their products can specify the precise level of
sweetness they want—higher for candy bars, lower for bread.
It dissolves quickly and blends easily into almost any mix-
ture. It prevents soft candy and ice cream from crystallizing.
And it keeps bread and cakes moist and fresh-tasting.
Did you save room for dessert? If you had a Coke, the an-
swer is probably yes, because the HFCS and cane sugar in
soft drinks do two things that executives at McDonald’s must
fnd almost too good to be true. To begin with, soft drinks,
no matter how many calories they load you up with, don’t fll
you up the way solid food does.
So downing a Super Sized
drink doesn’t necessarily make you any less interested in Su-
per Sizing the rest of your meal—a boon to McDonald’s.
But from the fast-food industry’s point of view, it gets
even better than that. You might not have realized it, but
the fructose that comprises about half of the HFCS or cane
sugar in a soft drink makes you even hungrier.
To use the
industry’s term, fructose suppresses satiety. This means a
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giant drink laced with an overdose of fructose has the almost
magical property of making room for an even bigger serving
of fries, or maybe a little 270-calorie “apple pie” served in a
festively-colored cardboard sleeve. What more could a fast-
food company ask for? And why would anyone wonder why
two-thirds of adult Americans are overweight and a third of
us are obese?
Of course, none of these commercial advantages of HFCS
would do companies any good if customers didn’t like the
stuff. But we do like it, and what we like most is the same
thing that makes it hazardous to the depressive: the overdose
of glucose it delivers to the bloodstream that temporarily su-
percharges our energy and lifts our mood.
Turning something good into something bad
Sugars are benign foods if you don’t remove them from their
natural state, but when you separate a plant’s glucose from
the plant, you strip away the protections that Nature pro-
vides. There’s sugar in an apple, but it won’t hurt you, because
the apple’s fber retards the absorption of glucose into your
bloodstream, protecting you from a rush. When you remove
the fber, you throw away the protection. When you get rid
of everything but the sugar, you create something perverse
and dangerous, just as you do when you refne the relatively
harmless coca leaf into cocaine.
Glucose is a minor constituent of plants, and it won’t
harm you as long as it stays packaged in the plant that made
it. When you eat an apple, for example, you consume only
about 6 percent as much glucose as a thirty-ounce Coke de-
Separating glucose from its protective package and
concentrating it so it’s ten, twenty, thirty, or a hundred times
more potent than it is in Nature is like refning slow-burn-
ing crude oil into volatile gasoline. When you dissolve pure,
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high-octane glucose in favored, carbonated water or a high-
carbohydrate manufactured food like a doughnut or break-
fast cereal, you turn it into a dangerous, mood-altering de-
signer drug, something engineered to give you a fast, cheap
This, of course, is exactly what someone who is under-
exercised, sleep deprived, poorly nourished, and socially
isolated is looking for—something she can quickly consume
to boost her energy and mood. But it’s a manufactured kind
of energy and a synthetic form of comfort, and the artifcial
boost is no more sustainable than a stock-market bubble, and
is soon followed by a crash.
For those of us who are suscep-
tible, the crash takes the form of depression.
High-fructose corn syrup and other varieties of extracted,
concentrated sugar are loan sharks. When you’ve missed
payments on exercise and sleep, and you’re suffering an en-
ergy and morale defcit, the Sugar Mafoso arrives on the
scene with a fstful of empty calories to give you a boost. But
what is given is soon taken back, and with a punishing rate
of interest. Just as hard-up debtors only dig the hole deeper
when they accept help from pitiless lenders, people who get
trapped in the cycle of borrowing from Sugar Daddy wind up
falling farther and farther behind.
Any food product with a high white-four content has a
similar effect. White bread isn’t sugar when it goes into your
mouth, but quickly converts to sugar during digestion.
products with a high sugar or white-four content carry what
nutritionists call a high glycemic load, or GL, meaning that
they spike your blood glucose level to give you a rush. Most
of us think we just like the taste of high-GL foods, but we’ve
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actually become dependent on the high they give us. In other
words, we’re sugar addicts.
So it was no surprise that when researchers at Brookhaven
National Laboratory scanned people’s brains while showing
them high-GL foods like pizza and ice cream, the brain areas
associated with addiction lit up in a way that was almost in-
distinguishable from the response of cocaine addicts when
You may be more familiar with the frst cousin of the gly-
cemic load measurement, the glycemic index. It’s an older
measurement that tells you how fast and how far your blood
glucose level spikes in response to different carbohydrates.
It’s a useful guide, but because the glycemic index, or GI,
measures only how fast the carbohydrates in a portion of a
particular food turn into blood glucose, ignoring how much
of those carbohydrates the portion contains, it can lead to
nutty conclusions. For example, the glycemic index says that
a Mars Bar is better for you than a parsnip, and that a slice of
watermelon will give you a heart attack faster than a slice of
pecan pie. The more recently devised glycemic load measure-
ment makes more sense, because it too accounts for how fast
the carbohydrates in the food turn into blood sugar, as the GI
does, but also factors in the amount of those carbohydrates
in the food (low in parsnips and watermelon, high in Mars
Bars and pecan pie).
High-GL foods include:
Most baked goods and desserts
Most packaged snack foods
Most cold breakfast cereals including corn fakes
Spaghetti and other macaroni products made with
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These happen to be the foods most of us think of giving up
frst whenever we think about going on a diet. But it’s impor-
tant to keep them off your plate most of the time even when
you aren’t dieting. Whether you’re fat or thin, high-GL foods
reduce your emotional buoyancy by putting you on a sugar
roller-coaster that always ends up at the bottom. Plus, eat-
ing a lot of high-GL foods eventually raises your blood sugar
level permanently, not just after you’ve eaten, and can lead to
Death by sugar
In 2006 Britain’s leading medical journal, the Lancet, re-
ported that eating too much sugar and white four kills three
million people around the world every year.
tionate number of those three million are Americans.
as many Americans as there are flling hospital beds thanks
to high-GL foods, there are even more under the covers in
their own beds at home, the victims of depression brought on
in part by the effects of food. The foods that ultimately stop
hearts are the same ones that start mood spirals, making life
feel like death, before high glucose levels actually do you in.
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Many nutritionists recommend you keep your daily GL
score below 50. If you’d like to start counting GL points,
you’ll fnd a chart showing GL values for popular foods at
The website also links to diet books that can help you
Counting has never been my thing, so instead of totting
up GL points, I rely on this rule of thumb:
If it’s white or one of its main ingredients is white,
and it wasn’t white when the farmer shipped it,
eat it only on special occasions.
The rule tells me to eat brown rice, baked goods and pasta
made with brown fours, oatmeal and other brown grains,
All-Bran™ cereal, and no highly processed sugars.
Cholesterol causes depression
A glycemic overdose isn’t the only way to eat your way into
depression and poor physical health. Cholesterol and triglyc-
erides will bring you down, too, both emotionally and physi-
High LDL cholesterol (the bad kind) and excess triglycer-
ides usually show up in your blood together, and when they
do, health problems of one kind of another are sure to follow.
LDL cholesterol robs the body’s cells of oxygen and other nu-
trients by narrowing blood vessels to reduce blood fow. By
turning into plaque, it also hardens the walls of blood ves-
sels so they can’t expand to create extra fow when the body
needs it, further depriving the cells of oxygen. To throw you
a third strike, triglycerides thicken the blood and prevent it
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from carrying a full load of oxygen through the pipes that
cholesterol has already narrowed.
There’s also HDL cholesterol, the “good” cholesterol that
gives you some protection against the depredations of bad
cholesterol and triglycerides. If you’re low on it at the same
time you have too much of the bad stuff, circulatory prob-
The combination of high bad cholesterol, low good cho-
lesterol, and high triglycerides is a major factor, perhaps the
major factor, in coronary heart disease, and is frequently im-
plicated in heart attacks and strokes.
But before it ever kills
you, coronary sluggishness compromises all the body’s pro-
cesses, so even if you’re not sick in bed, you’re operating be-
low par. Mental processes are the frst to be affected, because
brain cells are less tolerant of deprivation than other types of
This means that long before a compromised circula-
tory system seriously threatens your heart or any other or-
gan below the neck, it begins affecting your brain. It reduces
mental acuity, creates memory problems, increases the risk
of dementia such as Alzheimer’s disease—and sets the stage
Statistical studies tell us there is a close connection be-
tween heart disease and depression.
The strongest link
between the two disorders lies not in the one causing the
other but in the common causes that they share. Among the
most prevalent of these common causes are excess choles-
terol and triglycerides in the blood, which arguably lead to
even more depression than heart disease. A few years ago
Charles Glueck, a researcher at Jewish Hospital in Cincin-
nati, found that 39 percent of his subjects who tested high
in cholesterol and triglycerides were depressed. After these
patients reduced their levels to normal, 91 percent of them
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How do you lower cholesterol and triglyceride levels?
Start with—can you guess?—sugar.
We’ve already talked about how the glucose in high-fruc-
tose corn syrup and cane sugar reduces your buoyancy and
runs down your system by inducing sugar crashes. On top
of that, the same glucose overdose, brought on by consum-
ing sugar or any other high-GL food, also triggers an insulin
surge that boosts triglycerides in the blood.
And it gets worse.
The fructose component in HFCS and cane sugar, com-
prising about half the molecules in these sweeteners, is a
highly favored raw material for your body’s fat factory. At
the same time you’re getting a buzz from the fast-burning
glucose in the soft drink or cupcake, your blood is getting
bombed with a torrent of triglycerides from the slow-burning
fructose overdose that’s in the same package.
And there’s still more.
If what you’re eating happens to be a doughnut or other
common commercial bakery product, your buoyancy and
other health functions may take yet a third—and the worst—
hit, thanks to the most perverse synthetic food ingredient
that ever sneaked past the sheriff: trans fat.
The worst food ever
Trans fat is another industrial product created for the sole
purpose of improving the corporate bottom line. To make it,
companies start with a fat that’s not so bad for you, like soy-
bean oil, and bombard it with hydrogen molecules that turn
it into a solid or semi-solid shortening. The process is called
partial hydrogenation. The result is a nutritional abomina-
tion that does something to you that all the butter and lard
and egg yolks in the world will never do: It raises the bad
cholesterol in your blood at the same time it lowers the good
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It’s a double-dose of harm that’s unprecedented
in an edible substance.
In terms of your health, dietary fats sort into four catego-
ries: win-draw, win-lose, lose-draw, and lose-lose.
Win-draw fats are monounsaturated fats and
omega-3 fats. Monounsaturated fats (olive oil, pea-
nut oil, avocadoes, and nuts) lower your bad choles-
terol—you win—without affecting your good cho-
lesterol—a draw. Omega-3 fats (oily fsh, walnut
oil, canola oil, faxseed oil) are even better. They
lower your bad cholesterol without affecting your
good cholesterol—and lower your triglycerides as a
Win-lose fats are polyunsaturated fats. They
include the liquid forms (but not the semi-solid
forms) of corn oil, soybean oil, and sunfower oil.
They lower your bad cholesterol—you win—but
also lower your good cholesterol—you lose.
Lose-draw fats are saturated fats. These are the
fats in meat and poultry, dairy products, and palm
and coconut oils. They raise your bad cholesterol—
you lose—without affecting your good cholesterol—
Lose-lose fats. These, the trans fats, should be a
crime, and in some places they are. They include
the fats in any fully or partially hydrogenated oil,
including Crisco, margarine, shortening, most com-
mercial baked products, candy bars, and snacks.
Most U.S. restaurants, and not just fast-food places,
use them for deep frying.
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Since July, 2007, if you own a restaurant in New York, you’ll
go to jail for using trans fats. Chicago is considering a simi-
lar law, and progressive cities like San Francisco and Seattle
surely can’t be far behind. Both Wendy’s and KFC, which
were once among the worst offenders, have eliminated trans
fats from their restaurants. So has Taco Bell. One day, per-
haps soon, trans fats will be banned throughout the U.S., just
as pesticide-laced foods were banned years ago. But today, in
most places, food processing companies and restaurants are
still getting away with murder.
Is “murder” too strong a word? Well, consider what the
Harvard School of Public Health is now saying. In the April,
2006, issue of the New England Journal of Medicine, a re-
search group at Harvard reported that trans fat is the most
deadly thing found in foods today, surpassing all food con-
taminants and pesticide residues as a poison. They said a
single serving of French fries or chicken nuggets contains up
to fve times as much trans fat as it takes to increase your risk
of a heart attack.
One order of fries, three Oreo cookies, a
tablespoon of margarine, a small bag of potato chips, a few
handfuls of microwave popcorn, a piece of cake made from
a cake mix, a slice of Mrs. Smith’s Apple Pie, a big bowl of
some cold cereals, four cups of coffee with nondairy cream-
er—consume just one of these every day, and you’re in trans-
fat trouble. The FDA says the average American eats three
times as much trans fat as, by Harvard’s estimate, it takes to
raise your heart-attack risk.
According to the Harvard study, trans fats are responsible
for one hundred thousand deaths in this country each year.
If an army were killing us off in these numbers, we wouldn’t
hesitate to call it genocide. Yes, it’s impossible to say who will
die from trans fats and who will survive. But the fact that
manufacturers and fast-food outfts point a gun at their cus-
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tomers that doesn’t always kill them, or that customers who
do take a bullet happen to have colluded in their own demise,
doesn’t make it something that any society should accept.
There’s simply no justifcation for companies’ inviting their
customers into a game of Russian roulette.
What can you do to stop being hurt by your food?
I follow the advice of Michael Pollan, the writer I men-
tioned in Chapter 2. A few years ago, Pollan became interest-
ed in what he calls “our national eating disorder,” and wrote a
book about it, The Omnivore’s Dilemma. He followed it with
a New York Times Magazine piece, “Unhappy Meals.”
article begins by summarizing, in seven words, his conclu-
Eat food. Not too much. Mostly plants.
The frst two words, “eat food,” sound silly, until Pollan ex-
plains that he means “food” as distinct from “food prod-
ucts.” A food product is anything made in a factory, sealed
in a package, and often labeled with a list of ingredients that
bring high-school chemistry lab to mind. In the supermar-
ket, what we might call food proper—produce, eggs, meats,
seafood—is typically displayed against the outer walls. What
occupies the inner aisles is mostly food products. In the su-
permarket, if you just steered your shopping cart around the
race track without ever driving it into the infeld, your diet
would improve markedly.
Here’s another Pollan rule of thumb I like:
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Don’t eat anything your
wouldn’t recognize as food.
This tells us it’s okay to eat a moderate amount of chemical-
free, low-technology bread and other processed products that
have stood the test of time, but anything containing techno-
ingredients that are known to be dangerous, especially high-
fructose corn syrup, other extracted sugars, and trans fats,
are out. The rule also steers us away from substances whose
possible health hazards are still unknown—ingredients list-
ed on the package that, as Pollan says, are “unfamiliar” or
Eat mostly plants
People who live near the Mediterranean and in Asia eat less
meat and more plants than we do, and many researchers be-
lieve that’s why they suffer less cancer, heart disease, and de-
pression than Americans.
A 2007 study of three thousand
women in Shanghai found that those past the age of meno-
pause who ate a Western-style diet heavy in meats, sweets,
and dairy products suffered 60 percent more breast cancer
than women of the same age who ate a traditional Chinese
diet emphasizing tofu, vegetables, sprouts, beans, and fsh.
One advantage of a mostly-plants diet is that plants are
free of saturated fats, the lose-draw fats in animal products
that increase bad LDL cholesterol in the blood. It’s likely there
are many other advantages as well that we don’t understand
E N D ¡ N G NU T R ¡ T ¡ O N A ¡ R E C K ¡ E S S N E S S 111
Not too much
Pollan doesn’t mention that if you follow his frst prescrip-
tion—“eat food”—and his last one—“mostly plants”—the sec-
ond piece of advice—“not too much”—pretty much takes care
of itself. In general, plants pack fewer calories in each mouth-
ful. Even if you pile your plate high with them, it still won’t be
as fattening as the smallest Swanson’s frozen dinner. This is
because vegetables and fruits are full of non-digestible fber
that flls you up without flling you out. For example, a 2007
Penn State study shows that when you start off a meal with
some home-made vegetable soup, you wind up being satisfed
with 20 percent fewer calories for the meal as a whole.
Assuming you cover your protein needs with reasonable
amounts of meat, poultry, eggs, dairy, and seafood (or the
vegetarian protein equivalents), a plate dominated by vegeta-
bles and fruit will also be more nutritious. And if you think
it’ll be any less enjoyable, that’s only because you’ve forgot-
ten that it’s plants that give cooking most of its favor. Both
haute cuisine and good home cooking depend on plants to
make dull meat protein interesting to eat. Even McDonald’s
knows this. Without the Special Sauce made with vegetables
and herbs, the Big Mac wouldn’t taste all that different from
the cardboard clamshell it comes in.
In spite of what your food addiction may whisper in your
ear—“you need a cookie, and you need it now”—you don’t
have to eat harmful food in order to be happy and satisfed.
Here are some ideas to help you kick the habit and start en-
joying food for its taste instead of its addictive allure.
UP W ¡ T H O U T ME D S 11z
Just say no to fast-food restaurants
As an internal McDonald’s memo puts it, “We don’t sell nu-
trition and people don’t come to McDonald’s for nutrition.”
What McDonald’s and other fast-food outfts do sell is a quick
fx for addictive cravings. The only way to stop the cravings is
to stop feeding them. Every time you head for the line at the
counter or drive-up, picture yourself as an alcoholic walking
into a bar, and walk the other way.
Discover that harmful foods aren’t
really about satisfaction or enjoyment
It feels good to eat the high-glycemic, fatty foods you crave,
but only because you’re hooked. When you clean up your sys-
tem and kick the habit, you’ll fnd you enjoy eating the things
your body really wants more than you ever enjoyed the trippy
highs or soothing heaviness of comfort food.
Ride the virtuous circle
The more healthful foods you eat, the less you’ll crave un-
healthful foods. It takes a bit of effort to break some of your
bad-food habits, but once you have some success, it gets eas-
ier and easier.
Handle your negative attitudes
about vegetables and fruits
If edible plants were people, they’d have a strong discrimina-
tion case against most of us in this country. In the American
consciousness, meats are front and center, with second-class
citizens like spinach and broccoli sitting in the back of the
E N D ¡ N G NU T R ¡ T ¡ O N A ¡ R E C K ¡ E S S N E S S 11¤
If we adopt some of the eating attitudes of Italy and
France, two of places where food is rightly worshipped, we
can enjoy life fully and stay healthy, too. We don’t have to
count calories or GL points, just do what traditional Italians
and French people do: Eat real food, take the time to savor
it, and keep saying non, merci to the addictive food products
beckoning to us in the interior aisles of the supermarket.
If you don’t adore vegetables, assume
it’s because you don’t really know them
You may have formed your opinion about vegetarian dishes
based on experiences with inferior, dull-tasting products
prepared with little heart and less creativity. When I got off
my high-horse about vegetables and learned how to cook
them well, my wife said she didn’t care if I never fed her an-
other piece of animal protein. The cookbook that opened her
eyes and mine is Deborah Madison’s Vegetarian Cooking for
Eat more seafood
Some people have been scared away from seafood by news
stories about concentrations of harmful mercury and other
environmental pollutants in the fesh of fsh and shellfsh,
but a 2006 Harvard School of Public Health study, the most
comprehensive look at the subject ever undertaken, con-
cludes that the health benefts far outweigh the risks, which
the study found to be negligible.
(One exception: The study
endorses the FDA’s recommendation that women who are
or might become pregnant, nursing mothers, and children
avoid swordfsh, shark, king mackerel, and tilefsh, and eat
no more than six ounces of albacore tuna per week.)
UP W ¡ T H O U T ME D S 11q
The Harvard study found that just three ounces of farm-
raised salmon a week can cut your risk of dying from heart
disease by 36 percent and reduce your overall chances of dy-
ing by 17 percent. Other studies show that omega-3 fatty ac-
ids, present in oily fsh like salmon, are the secret ingredient
that led our ancestors to think of fsh as “brain food,” be-
cause they improve cognitive function, including the ability
to overcome depression.
All in all, says the Harvard study’s
lead author, Dariush Mozaffarian, “seafood is likely the sin-
gle most important food one can consume for good health.”
Don’t kid yourself about “health foods”
When you go into a health-food store or health-food depart-
ment in the supermarket, it’s a mistake to expect to be pro-
tected from bad nutrition just because you’re in a place that
has “health” in the name. Never mind how many times “nat-
ural” and “organic” appear on the package. Read the ingredi-
ents list, and prepare to be dismayed.
Don’t substitute supplements for healthful food
Food supplements may have a place, but they can’t offset the
damage done by an addictive, high-glycemic, cholesterol-
boosting diet. Americans spend sixteen billion dollars a year
on dietary supplements,
and still we have the highest rate
of food-related diseases in the world.
There’s no dietary
shortcut to good health.
Educate your family
If you share meals with someone else, the food issue can be-
come complicated. But it also means the urgency increases,
because now we’re talking about the health of not only you
but at least one other person. Persuading someone else in
E N D ¡ N G NU T R ¡ T ¡ O N A ¡ R E C K ¡ E S S N E S S 11=
your household to change his eating habits requires lead-
ership and salesmanship. But if you yourself are absolutely
convinced that eating right is as important as, say, wearing
seat belts and not smoking—and it is that important—you’ll
make the sale.
Shop at a farmer’s market
or buy a share in a local food crop
If you have a farmer’s market near you, it’s an opportunity
not to be missed. The food is fresh, mostly organic, and deli-
If there’s a community-supported agriculture (CSA) farm
near you, buy a share of the farm’s crop. It’ll provide you with
a basket of fresh, usually organic, locally-grown food every
week during the growing season.
For more information on locally-grown food and to fnd
out if there’s a farmer’s market or CSA in your area, see the
links at 5decisions.com.
The fve-million-year-old body
You may be living in the Information Age, but your body is
still back in the Pliocene Epoch, and it wants to be treated
like the splendid throwback it is. In the period since your
grandparents were born, human culture has evolved at a
head-spinning rate, while the human body hasn’t evolved at
all. Your body still wants to breathe no gas other than the one
it was inhaling at the very beginning. For quenching thirst,
it still fnds nothing to prefer over a beverage that came on
the scene billions of years ago. And, except for a recently-ac-
quired tolerance for cow’s milk, it still wants the same foods
that people were eating a thousand generations ago.
UP W ¡ T H O U T ME D S 116
The human body, like everything in nature, has the abil-
ity to adapt, but it takes time. You can’t expect to see any
evolutionary change over a sixty-year period, the short span
in which we’ve thrown so many new things at our bodies.
Given enough millenia to catch up, humans could probably
even learn to stay healthy and buoyant eating a diet of high-
fructose corn syrup and trans fats. But for the humans of the
twenty-frst century, recovering from depression requires
eating nineteenth-century food.
N I N E
r e - j o i n i n g t h e hu m A n r A C e
S o c i a l i s o l a t i o n i s h a z a r d o u s t o y o u r h e a l t h ,
a s d a n g e r o u s a s s mo k i n g t wo p a c k s a d a y.
hen Tom Hanks is stranded alone on an island in
the movie Cast Away, he teaches himself to spear
fsh, improvises his own dental treatment, and
predicts the weather with a calendar that he fashions himself.
But his self-suffciency goes only so far. The most important
item in his improvised survival kit, it turns out, is a friend.
Hanks paints a face on a volleyball, christens it “Wilson,” and
begins a one-way dialog with this pretend companion, a con-
versation that continues for four years. When Wilson later
foats away on the ocean current, Hanks’ anguish reminds us
that perfect self-suffciency, for a human being, is not achiev-
The movie suggests that without the companionship of
Wilson, Hanks would be in danger of losing his mind. But
you don’t have to be shipwrecked to be so lonely that it affects
your mental and emotional wellbeing. There are millions of
people in the U.S. today who have marooned themselves on
an island of their own making, and most of them are suffer-
Every ten years USA Today asks people how often they’re
seeing each other socially. In 1990 the average was six times
a month. Just ten years later it was a third of that.
It’s a trend
of increasing isolation that began about sixty years ago, a
pattern that parallels the doubling of depression in every
generation since the Second World War and has helped feed
the depression epidemic.
UP W ¡ T H O U T ME D S 118
Going without a regular diet of social interactions, say
many researchers, is as bad for you as smoking two packs
of cigarettes a day.
A 2007 study at UCLA showed that
chronically lonely people wind up suffering cardiovascular
deterioration and impaired immunity, setting the stage for
heart trouble and a host of other illnesses.
Someone who is
socially isolated is up to fve times more likely to die of all
causes than someone who has close ties with those around
In places where social bonds measure strongest, like
Hawaii, Minnesota, and Utah, people live up to eleven years
longer on average than in states where connections are not
The link between isolation and depression is also clear,
and we’re beginning to understand how the two are con-
nected. John Cacioppo, a University of Chicago psychologist,
has conducted a series of studies that pinpoint the negative
effects of loneliness that contribute to depression, including
increases in stress hormones like cortisol, a driver of depres-
Isolation as both cause and effect
Everyone knows that people who are in the middle of a de-
pressive episode often keep to themselves. But most depres-
sives are relatively unsociable even before the depression hits.
If that’s your story, you may have some interest in changing
when you realize that other people aren’t just there to provide
opportunities to be distracted or entertained, but play an im-
portant role in your emotional health.
You may say, “I’m not a joiner,” implying that you’re so
self-suffcient, you can get along without other people. But
I’m sorry, it’s a dodge. You weren’t made to live the solitary
life, any more than a dog or dolphin is. “No man,” as the poet
John Donne wrote, “is an island”—no matter what he tells
R E - J O ¡ N ¡ N G T H E HU M A N R A C E 11¤
himself. It’s possible there’s a member of our species some-
where who avoids other people without becoming depressed,
alcoholic, or sclerotic, but if so, I haven’t met him. Nor do
such people turn up in any of the studies. Nor do I believe
you’re one of them.
No one is so poorly adapted, so alienated, or so damaged
that he’s better off by himself. This was underlined by a re-
cent study of the California prison system, where they found
that inmates in solitary confnement commit suicide at a rate
twenty times greater than prisoners who are able to interact
with each other.
Even sociopaths need people.
The late Abraham Maslow, who pioneered an early ver-
sion of what is now known as positive psychology, placed
“love and belonging” right in the middle of the hierarchy of
human needs, just above “safety” on his iconic pyramid. He
said people need companionship even more than they need
other people’s approval.
Until about sixty years ago, that need was met for almost
everybody, including those with introverted tendencies, be-
cause regular, meaningful social contact was almost un-
As a farmer’s wife, my Grandma Myers worked long hours
to help make ends meet, but there was always plenty of time
left over for neighbor visits, church services, sewing circles,
pot lucks, ice cream socials, and club meetings. If someone
was having diffculties, Grandma, along with everyone else,
dropped everything to go and help them, and when she and
Grandpa were in need, the favor was returned. To use the
term coined by the American anthropologist Edward T. Hall,
grandma lived in a high-context culture—one based on deep,
longstanding connections, general agreement about what’s
real and what’s important, and strong networks of mutual
support. Because of the milieu in which she lived, she didn’t
UP W ¡ T H O U T ME D S 1zo
even have to make an effort to get involved in the community.
It opened its arms to her when she frst arrived in town as a
young woman, and held her in its embrace for the next forty
years. She couldn’t have kept herself apart if she had wanted
to. Togetherness—high context—was part of the package.
A world of soloists
The family farm has all but disappeared, together with the
lifestyle that went with it. Where my grandparents’ farm was,
there is now a suburb. Few people living in the tract houses
that have sprung up there in the last few decades were born
anywhere near the acre or so where they currently make their
home. Most will not be there ten years hence.
Many aren’t there even now. They’re at work in the city, or
by themselves in a car somewhere on one of the area’s high-
ways, or walking amid strangers at the mall. And among those
who happen to be present in the suburb at any given hour of
the day, there is no sign of them. They’re behind locked doors
in their homes.
Suburbs give the appearance of a community, but in fact
there isn’t much more real communal life in most of them
than there is in a scale-model village displayed on an elec-
tric train layout. As the urban architects Andres Duany and
Elizabeth Plater-Zyberk said, the suburbs are “the last word
in privatization,” a social arrangement that minimizes inter-
action, and that “spells the end of authentic civic life.”
The city as hiding place
Something similar has happened in the cities. Before the
Second World War, every city was a veritable hive, where so-
cial interaction was as unavoidable as noise. In 1960, Lewis
Mumford, the American architect and critic who spent much
R E - J O ¡ N ¡ N G T H E HU M A N R A C E 1z1
of his life pondering the role of urban design in human well-
being, wrote: “…the great function of the city is…to permit,
indeed to encourage and incite, the greatest potential num-
ber of meetings, encounters, challenges, between all persons,
classes and groups, providing, as it were, a stage upon which
the drama of social life may be enacted….”
It was only with-
in Mumford’s lifetime that the city came to be almost the op-
posite of the ideal that he described.
When Mumford was born in 1895, and for approximately
the frst half of his life, cities swarmed with opportunities for
bumping into friends, acquaintances, and extended-family
members. As he observed, and the Canadian urbanist Jane
Jacobs later argued,
these opportunities were built into
the very architecture of the city, in the stoops, courtyards,
butcher shops, food stands, taverns, union halls, ball felds,
and bandstands of urban neighborhoods. From before 300
B.C., when Alexandria became the frst urban center to reach
one million population, all the way up to Mumford’s middle
age some two millennia later in New York, a city was a place
where you couldn’t leave the house without bumping into
somebody you knew.
It’s been a few decades since a stoop appeared in the plans
for a new building in New York, and when we talk about life
on the streets now, we’re usually referring to something sin-
ister and scary, an experience to be avoided. Now the city is
a place where it’s best to keep your nose down, an unfriend-
ly environment where, if you’re smart, you mind your own
business. Now, when you’re walking in the city, human inter-
action is just what you hope won’t occur.
UP W ¡ T H O U T ME D S 1zz
Shallow roots make transplanting easy
Because our communities have become less communal,
we’ve found it increasingly easy to leave them. We now rou-
tinely cut our ties whenever something better comes along—a
better job in another city, a better neighborhood thirty miles
away, or a better school on the other side of town. Only a few
decades ago, most Americans lived their entire lives within
walking distance of the house they grew up in, forming bonds
for life. They worked for the same company, belonged to the
same clubs, saw the same friends. Now, one-sixth of the na-
tion moves every year, often to another part of the country.
And every year, one-ffth change jobs.
Even if you have rooted yourself in one spot, you may
no longer fnd time to build strong relationships outside the
house. The nourishing interactions that were part of every-
day life have largely been replaced by longer work hours, soli-
tary commutes, lonely shopping trips, and, above all, televi-
sion (and the Internet). In Bowling Alone, his masterpiece
that charts the steeply decreasing rate of social interaction in
American life over the last half-century, Robert D. Putnam
says that, compared with just a few years ago…
Club meeting attendance is down by half
Church attendance is down 25 percent
Home entertaining is down by half
Social visits are down 40 percent
To be sure, these trends have been partly offset by other de-
velopments in American life that provide new opportuni-
ties for social contact, above all in the workplace. With more
women joining the workforce, with the middle class working
R E - J O ¡ N ¡ N G T H E HU M A N R A C E 1z¤
longer hours, and with more people working past what used
to be considered “retirement age,” work has become the new
forum for social interaction. But in trading the neighborhood
community for a community centered on productivity, we’ve
traded down. Our freedom to socialize at work is constrained
by the fact that our time is owned by our employers; social in-
teraction has to take second place. And the emphasis that has
to be placed on results at work means that the culture of the
offce is a low-context culture, where people are more often
seen as a means to an end, rather than as fellow human be-
ings with whom we can experience and celebrate our mutual
Most people say they have no close friends at work, which
helps explain the increasing mobility of the American work-
force. With connections so shallow, it isn’t hard to leave peo-
ple you know at Company A for a better opportunity offered
by the strangers at Company B.
Of course, we now have cellphones, email, instant mes-
saging, online forums, blogging, social websites, and many
other new technological wonders that connect us with other
people everywhere. Research suggests that these connections
are worthwhile, but their impact on our wellbeing is limited
by the fact that they tend to be emotionally limited.
In spite of new opportunities for social interaction provided
by work and by the new forms of connectivity, more people
than ever report feeling isolated. According to the journal
American Sociological Review, the number of close friends
people have has declined steeply in recent decades, with 25
percent of us now saying we have no close friends at all.
Today four out of fve say the only people they have to con-
fde in, if they have anybody, are their relatives.
UP W ¡ T H O U T ME D S 1zq
Coontz, who studies the history of marriage, reported in the
New York Times that in the last twenty years, the number of
people who say they have no important conversations with
anyone other than their spouse has doubled.
Research tells us that marriage can provide important
protection against depression and other ills fostered by isola-
but when your only close friend is your spouse, it cre-
ates a dependency that can put strains on the relationship,
and also means you’re at risk of becoming totally isolated if
the marriage ends.
(As a group, people who have been di-
vorced without remarrying are more depressed than people
who are married or have never been.
) But even if you’re
married to the love of your life and you’re both headed for a
fftieth anniversary, a good marriage can’t do it all for you.
We all need regular contact with people outside the family.
Marriage isn’t providing as much social contact as it used
to, either. Since 1940, the percentage of married households
in the U.S. has dropped by a third, with more than half of
all U.S. women now unmarried.
Some of this decrease is
the result of more couples living together outside of mar-
riage, but it’s also true that more people in the U.S. are living
And among those who do have someone to live with,
they’re not spending as much time with their partner as they
used to, thanks to two-career households.
Togetherness equals happiness
Research shows that no matter what we say we want—money,
success, a new house, better schools for the kids—what really
makes us happy is other people.
As Robert D. Putnam ob-
serves in Bowling Alone, “The single most common fnding
from a half century’s research on the correlates of life sat-
isfaction...is that happiness is best predicted by the breadth
and depth of one’s social connections.”
When Edward Die-
R E - J O ¡ N ¡ N G T H E HU M A N R A C E 1z=
ner of the University of Illinois and Martin Seligman of the
University of Pennsylvania conducted their famous study
that asked, “How do the happiest 10 percent of the popula-
tion differ from everyone else?” they found that the biggest
winners in the satisfaction derby are those who spend the
least time alone.
But does socializing make people happy, or do happy peo-
ple just tend to get out more? It works both ways. Of course,
it’s no surprise that cheerful people gravitate toward others.
But studies also show that a stay-at-home introvert can in-
crease her happiness by getting more involved with her fel-
How do you establish the strong social connections that
are essential for both physical and mental health, after years
of holding yourself apart? Here are some suggestions:
Stop kidding yourself about how self-suff-
cient you are. It is possible to adapt to isolation
so well that you no longer notice what’s missing, but
this doesn’t mean it’s a healthy way to live. Even if
you don’t experience loneliness, being by yourself
most of the time will, sooner or later, affect your
emotional buoyancy as well as your physical health.
Try out the idea, if only in theory, that what you
may have been telling yourself—“I can get along
fne without other people”—may not be true.
See socializing as a health requirement in-
stead of an entertainment option. My think-
ing was always along the lines of: “Getting together
with other people is something to do for enjoyment.
Since I enjoy being at home by myself, why go out?”
But enjoyment, though important, isn’t always the
main point, especially if you’re susceptible to de-
UP W ¡ T H O U T ME D S 1z6
pression. Getting out with other people is some-
thing you simply have to do to stay healthy.
Recognize differences in emotional rich-
ness. Just as some foods pack more nutrients than
others, different modes of social interaction provide
varying amounts of emotional nutrition, and the
more you get, the better it is for your buoyancy. You
can estimate how rich an interaction is by measur-
ing three different dimensions: charge, bandwidth
Charge specifes whether the interaction is
positive or negative. Only a positive interac-
tion offers emotional richness. How do you
know it’s positive? When you wind up feeling
closer to the other person. The content of the
conversation matters less than how you feel
at the end of it. So even if you start out fght-
ing with someone but wind up having warm
feelings about her as a result of clearing the
air, it’s a positive interaction. Conversely, if
you’re all smiles because you’re pretending to
be friends, and you walk away resenting her,
you’ve had a negative interaction.
Bandwidth measures the richness of stim-
uli in an exchange. An email is narrowband,
because it’s just written words. A face-to-face
conversation is broadband, because there are
sights, sounds, and sometimes physical con-
tact, along with the words. In the middle of the
range, between broadband and narrowband,
you have things like phone conversations and
videoconferencing. In general, the greater the
R E - J O ¡ N ¡ N G T H E HU M A N R A C E 1z;
bandwidth, the richer the exchange, and the
better it is for your buoyancy. Modern com-
munication devices have become indispens-
able in business, but because they can’t convey
the full range of human communication, they
haven’t come close to replacing face-to-face
meetings. For the same reason, weddings and
funerals aren’t conducted through teleconfer-
Depth has to do with intimacy or heart con-
nection. When the cashier at Wal-Mart greets
you robotically, without looking up from the
scanner, it’s a high-bandwidth interaction, be-
cause she’s right there (barely). But there’s no
depth. When you have a heart-to-heart conver-
sation with your best friend about something
meaningful to both of you, that’s depth. In be-
tween are casual chit-chat, story-telling, and
working or playing together. In general, the
greater the depth, the more emotional rich-
ness, and the better it is for your buoyancy.
If you keep these distinctions in mind, it’ll help you
fnd ways to engage with other people that fll you
with life and improve both your physical and emo-
tional health. And you may discover that people are
a lot more fun than you might have guessed.
Become a joiner. It isn’t enough to say you’ll start
accepting more invitations, or that you’ll try to get
out more. You have to be proactive about this, or
you’ll be by yourself forever. You need to create a
structure for yourself that will draw you out of the
house. This means joining some groups.
UP W ¡ T H O U T ME D S 1z8
You may be averse to this idea, maybe because
you don’t have much experience with groups, or
perhaps because your experience with groups has
been negative. But trust me, you have it in you to
enjoy being with other people. They just have to be
the right people. No matter how much of a loner
you think you are, it’s possible to fnd groups that
suit you. Here’s how:
If you’re shy, choose highly structured
activities. Shyness is a common characteris-
tic among people who get depressed, and is of-
ten the reason we avoid other people. If that’s
a problem for you, choose groups where you
won’t have to do a lot of conversational im-
provising. A dance class, PTA meeting, or vol-
unteer charity might be the answer. But don’t
allow yourself to hide behind the structure
entirely. Stretch a bit, and start a conversation
with someone. You may be surprised how well
you do, especially when you and the other per-
son share the same interest.
Play to your strengths and your pas-
sions. When you’re choosing a group, pick
one where you’ll be a bit of a star. If you’re a
performer but you never got good grades in
English, join a theatre group, not a writing
group. Some people with self-esteem prob-
lems gravitate toward activities where they’re
at a lower skill level than others in the group,
on the theory that they need a big dose of
self-improvement. But remember, the self-im-
provement we’re mainly looking for here is the
R E - J O ¡ N ¡ N G T H E HU M A N R A C E 1z¤
buoyancy and health boost you get by enjoying
other people, and it’s often easier to do that
when the others are admiring you. So do what
you’re already pretty good at. And if you’re so
good at it that you’re qualifed to show others,
sign up as a teacher. It’s one of the best oppor-
tunities for emotional nourishment. The more
meaningful an area of interest is to you, the
more you’ll enjoy yourself, the easier it will be
for you to connect with other members, and
the less likely you’ll miss meetings or drop out.
So what are you passionate about—art, God, a
sport, dogs, the future of our kids, social jus-
tice, the environment, or something else? I’ll
bet you can come up with at least three things.
Whatever they are, there are plenty of people
near you who feel the way you do about these
things and will be glad to welcome into their
group someone like you who shares their pas-
Include others in something you’re now do-
ing solo. There’s almost nothing you can do alone
that can’t be done with someone else. Even writ-
ers, of all people, have clubs. If you’re a reader, join
a book club. If you’ve been skiing alone, join a ski
club. If you’re sitting at home alone because you
don’t agree about anything with anyone, join an
If you’re married, don’t insist that your
spouse join along with you. Joining with your
spouse is okay, but if there’s a club that’s good for
you but not for your spouse, spread your wings and
UP W ¡ T H O U T ME D S 1¤o
fy solo. Many married people who are suscepti-
ble to depression spend too much time with their
spouse anyway, so getting out on your own a couple
of nights a week will be good for you. And without
your partner to lean on, you’ll get more involved
with the other people in the group.
Nourish yourself by giving of yourself. Many
people lose their shyness when they’re serving oth-
er people, because it takes their attention off them-
selves. If you’re inclined to do volunteer work at a
hospital, charity, or some other place where people
have a need, it’ll do wonders for your buoyancy.
Research shows that social service relieves depres-
sion more effectively than any other form of inter-
If there’s a nursing home in your area, you could
make regular visits to it and get to know some of
the folks who live there. You’ll boost your spirits at
the same time you’re lifting theirs.
Consider joining a religious organization.
Religious groups certainly cause their share of
trouble in the world, but for emotional richness,
they’re hard to beat. They provide deep connec-
tions to other people and to the wider world and be-
yond. In calling religion “the opiate of the masses,”
even Karl Marx, an atheist, acknowledged the role
of religion in making people happier. And unlike
the chemical opiates, religion improves your health
instead of ruining it.
Spiritually, the U.S. has become ever more plural-
istic, especially with the popularization of Eastern
R E - J O ¡ N ¡ N G T H E HU M A N R A C E 1¤1
religions and their New Age variations. Unfortu-
nately, in the U.S. these “new” ways of being spiri-
tual tilt toward privatization, with more and more
people touching the Divine through books, CDs,
and solitary practices, rather than joining with
other people. There’s nothing wrong with this, but
all of us need the deep person-to-person connec-
tion that takes place “when two or three are gath-
ered together.” Fortunately, you can usually fnd a
group of like-minded people in your community to
commune with, no matter what your spiritual lean-
In the next chapter, we discuss the importance of
overcoming your worst addictions. This sometimes
means joining a 12-step recovery program. AA and
its spawn aren’t exactly religious organizations, but
the spiritual context in which they operate can pro-
vide deep connections among people.
Don’t quit until you’ve joined something
else. You may need to try a number of groups be-
fore you fnd the right ones. But don’t drop out until
you fnd a placement. Otherwise, it’ll be too easy
to go back to your old solitary ways. There may be
moments, especially right after you’ve joined, when
you’re uncomfortable with a group, or you’re bored,
or you have problems with some of the other mem-
bers. But if you remember that you’re doing this for
your own wellbeing, not just for enjoyment, it’ll be
worth hanging in there and riding out the rough
moments, at least until you fnd a group that works
better for you. If it helps, think of socializing as
UP W ¡ T H O U T ME D S 1¤z
something like going to the gym. It’s important to
do whether it feels good or not.
If you’d like some additional help overcoming social isola-
tion, you’ll fnd a several options for live, personal guidance
and support at 5decisions.com.
Rediscover your social self
You were born a social butterfy like everyone else, and that’s
what you still are underneath, no matter how much of a co-
coon you’ve wrapped around yourself as a response to early
hurts, or how many years you’ve practiced being alone. I don’t
care who you are or what your history is. If you’re human,
your soul longs for the warm glow of shared moments and
mutual affection. It’s time to listen once again to the sweet,
undefended part of yourself, which wants, with all its heart,
to be friends with others.
At this point in your life, fnding new friends may be just
a self-improvement project. But it won’t take long for you to
get the hang of it, and then you’ll fnd that togetherness feels
as natural as saying “hello” to an old friend. No matter what
you’ve told yourself in the past, you’ll fnd that you’re happier
than you were when you holed up at home or at work. You’ll
be healthier, more energetic, and more buoyant. And you’ll
fully realize what you’ve always known down deep:
Other people are what life is all about.
T E N
ge t t i n g of f e A s y
Ad d i c t i o n s r e l e a s e t h e i r h o l d o n y o u wh e n
y o u s t a r t g e t t i n g wh a t y o u r e a l l y n e e d .
epression and addiction are like a pair of drinking
buddies. Often found together, they feed off each
other’s darkness. If you’re a depressive, any addic-
tion that snares you will hold you hostage by threatening to
depress you if you quit. But you face a Catch 22 here, because
your addiction also depresses you when you don’t quit. This
damned-if-you-do-and-damned-if-you-don’t dynamic is why
ending depression usually requires giving up what you’re
hooked on for good.
The high-interest mood loan
In Chapter 8, I talked about how sugar and its abominable
twin, high-fructose corn syrup, operate like loan sharks,
boosting your brain’s available supplies of the mood-elevating
neurotransmitters serotonin, dopamine, and endorphins, but
then inevitably take back what is given, and with a punishing
rate of interest. Other addictions offer similar brain-chemical
subsidies and carry high repayment costs. Marijuana mimics
a neurotransmitter called anandamide, named after the San-
skrit word for “bliss.”
With cocaine, it’s dopamine, serotonin,
Gambling elevates dopamine and also
raises the level of norepinephrine and endorphins.
increases the level of four mood-elevating neurotransmitters:
acetylcholine, dopamine, glutamate, and endorphins.
pulsive gambling, shopping, and pornography boost norepi-
UP W ¡ T H O U T ME D S 1¤q
nephrine and endorphins.
Compulsive sex offers a wealth of
Most addicts don’t realize that neurotransmitters are what
they’re hooked on. It rarely occurs to someone who overeats
that she’s in it for the serotonin. Similarly, a smoker isn’t al-
ways conscious of the endorphins that food her bloodstream
when she lights up. She may believe it’s merely a habit, like
checking her hair when she passes a mirror. She might say,
“I always have a cigarette when I’m on the phone,” the same
way a drinker says a couple of beers are just part of his rou-
tine at the end of the day. But if you think your habit is about
something other than your mood system, try stopping, and
notice what happens to your mood.
You don’t see them coming
Many mood-boosters are wolves in sheep’s clothing. They’re
positioned as nothing more sinister than a social beverage,
a nice snack, a pick-me-up, a few hours of diversion at the
mall or casino, or maybe a little something in a baggy to help
you relax after a hard day. Most of these mood-altering op-
tions are so well disguised as legitimate products or innocent
pastimes that it’s easy not to notice that you’re using them to
improve your brain chemistry. You may think you’re merely
thirsty, hungry, tired, bored, or just in the mood for a little
fun. You may be experiencing pangs that feel something like
hunger or thirst, and not realize that what you’re really crav-
ing is neurotransmitters.
Depressives are addiction’s best customers
Once you understand what it is that really hooks you, it’s
easy to see why we depressives get addicted so easily. We’re
just trying to compensate for our chronic neurotransmitter
G E T T ¡ N G O ¡ ¡ E A S Y 1¤=
shortage by taking backdoor deliveries from unwholesome
Antidepressants that don’t come from Big Pharma
As antidepressants, beer, dessert, and marijuana all enjoy a
bigger share of the market than the pills sold by the drug
companies. Their commercial success as mood-boosters
is understandable, because these medications that we pre-
scribe for ourselves are more potent than any of the medi-
cines sold in the drug store as antidepressants.
we get hooked on are addictive precisely because they im-
prove brain chemistry so dramatically.
Outsourcing brain chemicals, whether through heroin or
refned carbohydrates, always comes at a price. And the big-
ger the portion, the higher the tab. You pay it in fve not-so-
The crash. When the temporary mood boost
wears off, you usually feel worse than you did to
Progressive tolerance. It often takes a bigger
dose—more wineglass reflls, more milligrams,
more adult “X”s, higher gambling stakes—to get the
same boost next time.
Entrapment. Feeling better is just the bait in a
bait-and-switch scheme. After a brief honeymoon
period, you don’t necessarily get the boost any-
more, but you keep going back for more, because
things have gone beyond any hope of feeling bet-
ter. Now it’s about how awful you’ll feel if you stop.
You signed up for help, and wound becoming de-
UP W ¡ T H O U T ME D S 1¤6
Deterioration. Any serious addiction takes a toll
on just about everything most of us value—physi-
cal health, personal integrity, self-esteem, spiritual
wellbeing, cognitive skills, relationships, work ef-
fectiveness, fnancial health, and, of course, emo-
Regression. Addiction is, metaphorically, an um-
bilical reattachment that robs you of your biochemi-
cal self-suffciency. By outsourcing your neurotrans-
mitter supply, you atrophy your already-enfeebled
endogenous capacity for good brain chemistry. In
doing so, you inadvertently collapse the last of your
inbuilt defenses against depression.
The National Institute on Alcohol Abuse and Alcoholism, an
agency of the U.S. Department of Health and Human Servic-
es, acknowledges the synergistic partnership of depression
and addiction when it reports that...
…the relationship between alcohol and tobacco depen-
dence and major depression is complex and self-sustaining.
Patients may drink or smoke in an attempt to “self-medi-
cate” to alleviate their feelings of depression. Additionally,
depression and anxiety are associated with cravings for
alcohol and nicotine. And long-term use of alcohol and
nicotine can produce low levels of the brain chemical se-
rotonin, which might trigger or worsen depression [my
The link between alcoholism and depression is highlighted
by a National Institute of Mental Health study that found the
rate of depression among alcohol-dependent men is three
times the average, and among alcohol-dependent women, four
G E T T ¡ N G O ¡ ¡ E A S Y 1¤;
times the average.
The study was statistical, which means it
drew no conclusions about which problem is cause and which
effect. But other studies make it clear that the relationship
That is, alcoholism fosters depression, and
depression encourages alcoholism.
When researchers in Britain tested patients admitted to
a hospital for severe alcoholism, they found that on the day
of admission, 67 percent were also suffering from major de-
pression. They tested again after the patients had been sober
for a few weeks, and found that the number who were still
depressed had dropped to 13 percent.
As with alcohol, the link between nicotine and depression
is bidirectional. People who are prone to depression take up
smoking to mitigate depression’s symptoms. Smoking in turn
triggers more episodes of depression. Its effects are so de-
pressive that a University of Helsinki study found that smok-
ers can cut their risk for depression in half just by giving up
In the U.S. during the past few decades, there’s been a grow-
ing movement to legalize marijuana. The pro-pot argument,
when it isn’t advanced along libertarian lines, is often based
on the claim that marijuana is nonaddictive and harmless.
But whether it is considered nonaddictive by certain tech-
nical criteria that may or may not be relevant, and putting
aside the question of whether it should be legalized, pot is not
harmless, at least in frequently repeated doses, and especial-
ly for depressives.
An Australian study found that teen-aged
girls who smoked pot every day wound up with fve times as
UP W ¡ T H O U T ME D S 1¤8
much depression within the next seven years, compared with
girls who abstained or smoked less.
A conucopia of dangerous substances
But it isn’t just alcohol, tobacco, and marijuana that form a
mutually-reinforcing relationship with depression. Anything
that gives you a big brain-chemical subsidy—cane sugar,
high-fructose corn syrup in soft drinks, refned carbohy-
drates, gambling excitement, sexual conquests, career and
fnancial triumphs, shopping “fnds,” or dangerous thrills—
has the potential, if you get hooked, to encourage depression.
(Antidepressant medications can be habit-forming for some
people, but because any change in brain chemicals is slight,
they’re less addictive than other substances.)
Addiction is the American norm
Like steep increases in physical inactivity, sleep deprivation,
and the other dramatic changes in American life that under-
lie the doubling of depression in every generation since the
Second World War, addiction rates have soared, feeding the
depression epidemic. “The United States,” says Elaine Gottle-
ib of McLean Hospital, “is a nation of addicts.” Drug use has
now surpassed heavy drinking, according to the U.S. gov-
Marijuana has become America’s fourth-largest
cash crop, bigger than wheat, cotton, or tobacco.
Americans abuse prescription painkillers like Vicodin and
But all the recreational and prescription drugs taken to-
gether have to take a back seat to the spectacularly popular
substance pushed by the big food processors: sucrose. To-
day, the average American is running two to three times as
much sugar through her system as the human body is built
G E T T ¡ N G O ¡ ¡ E A S Y 1¤¤
to handle safely.
And a compulsive sugar user isn’t doing it
primarily because she’s hungry, though she may think that’s
her motivation. She’s doing it for the neurotransmitters.
Addiction’s double whammy
Addictions don’t just encourage depression by damaging your
body’s neurotransmitter system. They also sabotage your
ability to do the very things that would restore the system
to health, interfering with all the things we’ve talked about
in previous chapters that are required for improving brain
chemistry and ending depression: exercise, adequate sleep,
wholesome eating habits, and meaningful social contact.
Bonding through addiction
Of course, some addictions lend themselves to certain forms
of low-grade socializing. For example, alcoholics often drink
together. But having a drinking buddy, shopping companion,
or pot circle isn’t worth much in terms of mood maintenance,
because it takes meaningful social contact to improve brain
chemistry. When addicts get together to indulge their addic-
tions, there’s often plenty of talk, but not a lot of it boosts
Though addictions can be tenacious, their power to enslave
has been overstated. As I mentioned in Chapter 2, I found it
relatively easy to end a thirty-year alcohol dependency, and
I know many others who’ve walked away from all kinds of
things—cigarettes, caffeine, alcohol, drugs, food addictions,
gambling, shopping mania, Internet compulsion—without
a struggle. It happens more often than you’d guess, but be-
UP W ¡ T H O U T ME D S 1qo
cause of the culture’s settled ideas about addiction, this posi-
tive side of the story is easy to miss.
Anybody, even someone in the grip of a well-established
addiction, can escape from its clutches, and can do it without
a painfully wrenching effort. Pain and effort are usually the
result of trying to overpower the addiction, pitting will power
and determination against the habit’s strong grip. This ap-
proach often doesn’t work. But if, before trying to quit, you
skillfully loosen the addiction’s grip, something wonderful
eventually happens: It just drops.
In a moment, we’ll talk about how you do that. If you’ve
been paying close attention to everything in this book so far,
you may already guess the answer. But frst, I need to ask an
Are you addicted?
It’s possible to be seriously addicted without being aware
of it, especially if the dependency is one, like food, that is
considered socially acceptable and for which denial is insti-
tutionalized in the culture. Or, even if it’s something like al-
cohol or drugs that everyone knows can be harmful, but it
isn’t seriously disrupting your life, it may be hard for you to
see it as a problem even though it may be one. Another pos-
sibility: You have a big problem, but there’s a part of you that
doesn’t want to know the truth.
If you’re in doubt, take the “Am I an addict?” test at
Addicted to distraction
In addition to the substances and activities that snare us,
there’s another group of dependencies that also encourage
depression, but not the same way alcohol and the other loan
sharks do. I call them occupiers, because they relieve the men-
tal unease of normal living by occupying your mind. They’re
G E T T ¡ N G O ¡ ¡ E A S Y 1q1
occupiers in another sense, too: They can take over your life
like an occupying army takes over a country. This category
includes television, the Internet, reading, video games, and
work. (The Internet can fall into the neurotransmitter-boost-
ing category of addiction as well, because it’s a gateway to
addictive gambling, shopping, and pornography. But here I’m
talking about the compulsive need to keep surfng, no matter
what the particular content.)
Occupiers don’t always turn into addictive habits, but
most Americans have become dependent on at least one of
them, developing noticeable withdrawal symptoms when TV,
or whatever they’ve become dependent on, is taken away for
any length of time.
What hooks you, though, is not a pleasurable rush, but a
welcome vacation from your own thinking—relief from the
usual tiresome jumble of obsessions, worries, plans, and
memories that parade through any human’s mind when she’s
not concentrating on anything in particular. Occupiers allow
you to lose yourself and your concerns temporarily.
Research shows that some of the diversions we use to oc-
cupy the mind, like TV and reading, actually have a mildly
They frequently leave people feeling a lit-
tle depleted when the set is turned off or the book is closed.
However, these little crashes aren’t usually enough to trig-
ger an episode of major depression or severely deepen one
that’s already underway. Like the other occupiers, their main
contribution to depression is to prepare the ground for a big
crash by diverting you from doing the things that maintain
your body’s mood-recovery system. When you become com-
pulsive about them, they monopolize your free time, crowd-
ing out the exercise, sleep, wholesome cooking, and social
contact that every depressive needs to maintain buoyancy
and keep depression at bay.
UP W ¡ T H O U T ME D S 1qz
The allure of the small screen
The average American adult spends half her leisure hours—
three a day—in front of the television
and, if she has an In-
ternet connection, almost half of what’s left of her free time
surfng the Web.
Depressives go even further, watching more
television and spending more time on the Internet than aver-
Alternately, many are bookworms and workaholics.
Whatever you may have become hooked on—TV, Internet,
books, or something else—it usually means you don’t have
enough time left to do the maintenance your body requires
for emotional buoyancy. That’s why it’s often necessary to cut
back on your habit, so you have time to get the exercise, sleep,
good food, and social contact required to keep from getting
Getting off easy
Now let’s talk about how you can give up an addiction with-
out a struggle.
First, ask yourself whether you want to quit. I’m sure you’d
like to quit, but does that desire outweigh other desires? Are
you really, really ready? There’s no book, no psychotherapist,
no treatment program, and no self-help group that can an-
swer that question for you. Only you can.
Quitting can be hard, and quitting can be easy, but if you
don’t sincerely want to quit, quitting will be impossible.
A 2005 study at the University of Miami confrmed what
many have long suspected: Treatment programs and self-
help groups like AA are able to claim a modicum of success
not because their methods are better than others but because
they attract people who have already decided to quit. Analyz-
ing statistics provided by the National Institute on Alcohol
Abuse and Alcoholism, the Miami research team found that
G E T T ¡ N G O ¡ ¡ E A S Y 1q¤
those who volunteered for a recovery study but didn’t attend
any therapy or 12-step sessions were almost as successful
in giving up alcohol as volunteers who attended all the ses-
It was standing up and saying, “I want to quit” that
got people to give up drinking, not a silver bullet delivered by
therapy or the 12-step process.
Trying to quit just because other people want you to
doesn’t work with an addiction any better than it works with
anything else. A 2007 study at the University of Rochester
found that a counseling program that helped smokers get
clear about their own reasons for quitting, as opposed to
reasons given to them by someone else, was more successful
than traditional counseling that tried to push them.
“I should want to quit” doesn’t work, either.
But even if you aren’t ready to quit now, it’s not the end
of the story. Most people quit eventually, even most of those
who seem beyond saving.
Your motivation will increase as
the addiction takes a greater and greater toll on your life,
and eventually, the statistics say, the cost will become high
enough for you to see that change is your best option.
But you don’t need to wait to hit bottom if you can fnd
in yourself the absolute desire to quit now, a desire that out-
weighs all your opposing desires. So take a look and see what
you really want to do. When you’re able to be honest with
yourself about this, it can save you a lot of trouble.
Powerless over alcohol?
In Step 1 of its 12-step program, Alcoholics Anonymous in-
troduces alcoholics to the idea that the addiction is bigger
than the addict. AA members learn to say, “We admitted we
were powerless over alcohol.” This can be a useful mantra,
because it helps the alcoholic own up to his experience of be-
ing a slave to the addiction, which he may have been denying.
UP W ¡ T H O U T ME D S 1qq
As I suggested a moment ago, “I can quit anytime I want” is
always true in a literal sense, but when an alcoholic says it,
it’s often a lie, because he doesn’t really believe it. So for some
people, it may be good to acknowledge this sense of helpless-
ness that’s underneath their empty boast, since admitting
the truth always makes us stronger. But like so many of AA’s
strategies, Step 1 can also make recovery seem harder than it
has to be. When AA encourages alcoholics to attribute god-
like powers to their addiction, they may forget that the choice
is always theirs to make.
So be honest with yourself. If your experience is that
your addiction is bigger than you are, acknowledge your feel-
ings of helplessness. But don’t make the mistake of thinking
your feelings have anything to do with objective reality. “I
am powerless over alcohol” isn’t really true. It’s just how you
feel. The reality is that most people do quit their addictions,
demonstrating that they aren’t powerless at all. And the vast
majority do it without going into a treatment or 12-step pro-
Many just wake up one day and decide they’ve had
enough. A surprisingly large number quit after a single brief
chat with their family physician.
Many others, I’m happy to
say, do nothing more than read a book like this.
Hard-core addicts, we’re told, don’t just walk away from
it. But they do. After returning from Vietnam, 90 percent of
the GIs who had become addicted to heroin while they were
overseas were able to quit in fairly short order—most without
treatment or a self-help group.
According to the National Survey on Drug Use and Health,
almost a quarter of young adult Americans abuse or are ad-
dicted to a substance, not including sugar.
But past experi-
ence suggests that only a handful of them—3 percent—will
still have a problem by the time they reach middle age.
G E T T ¡ N G O ¡ ¡ E A S Y 1q=
one else will have quit by then, and most of these recoveries
will have been achieved without a program of any kind.
The 1992 National Longitudinal Alcohol Epidemiologic
Survey found that three-fourths of all alcoholics who quit do
it without the beneft of a formal program, and these do-it-
yourselfers stay on the wagon more successfully than rehab
clients and 12-steppers.
Nicotine is one of the most addictive substances, yet most
cigarette smokers eventually kick the habit, and all but a
small minority do it without treatment, therapy, hypnotism,
patches, or self-help groups.
An even larger percentage of
heroin and cocaine addicts quit on their own.
This doesn’t necessarily mean you should stay away from
treatment or self-help groups. Millions of people, including
at least two dozen I know, have overcome addictions with the
help of structured programs, and these folks are usually eager
to tell you how important the support was to their recovery.
At the same time, you should be clear that no program can
ever do more than provide you with a supportive framework
for doing what you’ve already decided to do. No program can
quit for you.
And just as no one but you can quit your addiction, no
one can tell you the best way for you to quit. You’re the ex-
pert here, the only person qualifed to chart your route to
freedom. In the University of Rochester study I mentioned
a moment ago, smokers who designed their own recovery
plan were more successful at quitting than those who were
assigned to a program by somebody else.
If you know you’re the kind of person who performs best
in a well-defned structure, you may lean toward treatment.
If you’re comfortable with introspection or respond well
to coaching, psychotherapy could be a way to go. If you’re
a loyalist who’s comfortable embracing a system of beliefs
UP W ¡ T H O U T ME D S 1q6
as a matter of faith, a 12-step program may appeal to you.
If you’re interested in ending your addiction the same way
I did, by weakening addiction’s grip before quitting, check
out the options for live, personal guidance and support at
Whether recovery will be easy or hard doesn’t depend on
whether you get help or decide to do it on your own. What
matters most is not the form of support you choose but how
much preparatory work you do to loosen the addiction’s grip
before you attempt to shake it off. The thing to keep in mind
Every addiction serves a legitimate human need.
In order to recover from your addiction without a struggle,
you must fnd another way to fll the need that the addiction
serves. You have to make the addiction superfuous.
No one becomes addicted to something because she wants
to break up her marriage, disappoint people at work, get into
fnancial trouble, gain ninety pounds, or feel rotten in the
morning. Every addict gets started using alcohol, cigarettes,
dessert, snacks, drugs, shopping—or whatever—for one rea-
son and one reason only: to feel better. Every addictive sub-
stance and mood-boosting routine gets its hooks into people
by offering just about the most valuable thing on the market:
an improved experience of life.
What could be a more legitimate motivation?
People sometimes think that those of us who’ve fallen
prey to addiction are self-indulgent, weak, or self-destruc-
tive. Frequently, addicts even nod their heads in agreement
with this negative assessment. But is it true? Are you really
an insatiable hedonist who just can’t get enough pleasure?
Are you someone of low moral character who doesn’t have
G E T T ¡ N G O ¡ ¡ E A S Y 1q;
the strength to give up what stronger people can refuse? Are
you really out to wreck your life? I doubt it. What I think is
that you indulge because you have a powerful incentive to
indulge—one that’s based on sanity, not pathology. I think,
at least at the time when you started using, your addiction
was the best strategy available to you for feeling okay, when,
without that strategy, life didn’t feel so good to you. Now, fac-
ing the alternative of feeling much worse if you quit, the in-
centive to keep using is even greater. And since feeling okay
is a universal and legitimate human need, no one, including
yourself, has a right to condemn you for trying to improve
your experience. Ultimately, your refusal to settle for a life
that feels subpar, and to use the only means you’ve found to
make yourself feel better, is an expression of self-love, noth-
The crux of the matter
So do you see what the main problem about quitting is, and
why so many recovering addicts fall off the wagon?
For many people, giving up what they’re addicted to
means returning to an unacceptably low level of happiness.
When we think about recovery, we tend to focus on the
withdrawal period, since it can be so uncomfortable. But
withdrawal is actually the easy part, because the worst of the
symptoms disappear within a few days or weeks. Most peo-
ple can tough it out for that long. The more diffcult aspect of
recovery is getting past the detox stage and its sharp discom-
fort, and then fnding that everyday life, without the subsidy
of the brain-chemical loan shark, doesn’t feel so great. Unlike
the relatively short period of withdrawal, this stage of suf-
fering doesn’t have an end date. As far as you know, you’re
going to be feeling subpar permanently. It looks like a life
UP W ¡ T H O U T ME D S 1q8
When you experience life as something less than you be-
lieve it should be, and you know there’s a substance or mood-
elevating activity that will improve things, it makes perfect
sense to start using again. That’s the problem you have to
address if you want to quit your addiction without a struggle.
You must fnd a way to feel better that doesn’t addict you.
Only then will you be free.
So it all comes down to this question: Why doesn’t life feel
so good to you?
The monkey wrench in your life
You could blame certain conditions for your dissatisfac-
tion. You’ve got the wrong job, the wrong income, the wrong
spouse, the wrong skills, the wrong thighs, the wrong perso-
nality, the wrong brother-in-law. You’re living in the wrong
city, the wrong neighborhood, the wrong house, the wrong
century. Like all the rest of us, you fnd yourself in the wrong
world, a world degraded by war, poverty, injustice, immorali-
ty, crime, corruption, and global warming.
But is any of this really the problem?
The world can be a tough place for sure, and no one, as
far as I know, has ever been given an adequate set of tools for
negotiating her way through it easily. But you’ve been around
long enough and have enough self-knowledge to at least sus-
pect that chronic dissatisfaction with life may be related to
something inside you. Let’s be honest. You could win the
Powerball, and, though this would put you in a better frame
of mind for awhile, the time would come when you would still
need a drink (or whatever it is you depend on to improve your
experience). There are now thousands of multimillion-dol-
lar lottery winners who can testify to the truth of this state-
G E T T ¡ N G O ¡ ¡ E A S Y 1q¤
Or you may think your suffering has psychological ori-
gins—in your childhood, in your pessimistic outlook, in your
low self-esteem, or in genes that negatively impact your brain
structure and thinking. You may believe that your subpar ex-
perience of life is part of your personality. Or perhaps you see
your unhappiness as caused by emotional stress—another
psychological explanation. But are any of these things really
the fundamental source of your unhappiness?
As important as all these factors can be, a major source of
general suffering among Americans today is the same thing
that’s causing so much depression—defciencies in exercise,
sleep, good food, and meaningful social contact. When these
needs aren’t met, nothing, including your thoughts and feel-
ings, can be right. No amount of money, success, power, lux-
ury products, or positive thinking can ever compensate for
this defciency. No one who is under-exercised, under-rested,
poorly nourished, and socially isolated can hope to feel okay
without the aid of an addictive crutch.
Depression and addiction, the twin affictions that
darken your life, have the same source.
What I’m saying may not be self-evident to you since, chances
are, it’s been years since you’ve experienced the natural feel-
ing of wellbeing that comes when your body’s requirements
are met; feeling subpar is what seems normal. But if you’re
willing to try taking care of yourself the way Nature intends,
you can fnd out for yourself. You’ll discover that when you
start treating yourself as well as you treat your dog or cat,
and this TLC returns the happiness to you that you were born
with, the addiction loses the only hold it’s got on you. Then
quitting is easy.
UP W ¡ T H O U T ME D S 1=o
One program, two recoveries
Earlier I said that in order to end depression, you usua-
lly have to give up your most intransigent addictions. But
if you’re doing the other things we’ve already talked about
that are required to end your depression, you’re already dea-
ling with any addictions in the most effective way you can,
because you’re putting back in your life the things you need,
and that’s all it takes to loosen the addiction’s grip.
Making a vicious circle virtuous
I began this chapter by talking about the unfortunate pair-
ing of depression and addiction that makes them mutually
reinforcing. But the upside of this nasty partnership is that
recovering from both of them is synergistic, too. What you
do to easily overcome an addiction is exactly what you do
to build up your defenses against depression. There aren’t
two programs, one for depression and another for addiction.
There’s just one. Depression and addiction are caused by the
same thing. And they’re both cured by the same thing.
In the next chapter, we’ll discuss the frst step for ending
your depression. The frst step for ending your addiction will
be one and the same.
E L E V E N
to r t o i s e s r e C o v e r
fA s t e r th A n hA r e s
A n d i t d o e s n’ t ma t t e r wh a t y o u r
f i r s t s t e p i s , a s l o n g a s y o u t a k e o n e .
f you make the changes this book recommends, it could
be the most life-enhancing endeavor you’ve ever under-
taken. But the changes it’s going to require in order for
you to be successful—at least two or three of them, depend-
ing on how well you’re already tending to your needs—may
seem like just too much to take on. And they are too much,
if you were to try to accomplish all of them at once. But that
isn’t necessary, or even desirable. All you ever need to do is
take a single step.
A research team at the University of Missouri found this
out in 2007, when they were looking for the best approach
for recovery from Type II diabetes. They found that, even
though diet modifcation is theoretically the best route, and
exercise the second-best, patients who were encouraged just
to exercise did twice as well as those who were assigned both
exercise and diet modifcation. One step at a time was better
But what is the frst step to ending your depression?
That’s for you to decide. You can begin anywhere, as long
as you begin somewhere. Pick any of the fve lifestyle prob-
lems that underlie depression—exercise deprivation, sleep
deprivation, nutritional recklessness, social deprivation, or
addiction. You’ll fnd that when you take a single step toward
correcting any one of them, it’s a step toward correcting all
of them. Because each lifestyle problem feeds all the others—
UP W ¡ T H O U T ME D S 1=z
lack of exercise often encourages sleep problems, for exam-
ple—making progress in one area sets up a positive dynamic
in which they all tend to begin resolving. I’ve discussed this
in previous chapters, and my personal story, told in Chapter
2, dramatizes it.
A frst step that’s never wrong
However, if I were to pick a frst step for you, it would be
exercise, assuming it’s currently missing from your sched-
ule. Exercise, as I discussed in Chapter 6, doesn’t just build
aerobic capacity, strength, and fexibility. It is the mother of
all wellbeing. Thirty minutes of exercise three times a week
encourages sound sleep, acts as an antidote to harmful foods,
provides opportunities to socialize, and expedites recovery
from addictions. If you exercise longer or more frequently,
the benefts increase even further. Still, if exercise doesn’t
feel like the right starting point for you, choose another one
that does feel right. This is your journey, and you’re the one
who can best map the route.
Whoa, not so fast
But are you ready to take the frst step? Frankly, I have my
If you’re a typical American, you’re already overloaded
with too many challenges, and you aren’t going to get very far
if you try to pile even more on top of what you’ve already got.
Just as someone on a walking tour would soon have to drop
out if she were carrying two large suitcases and a poodle, an
individual setting out to make important changes in her life
can’t succeed if she’s carrying too big a load to begin with.
Many people believe they have time constraints that keep
them from completing new challenges, but if you examine
TO R T O ¡ S E S R E C O V E R ¡A S T E R 1=¤
your own life, I think you’ll see that the real limitation isn’t
time, but carrying capacity.
Time is rarely the problem
Many people I talk to say they don’t have time to exercise
three days a week, don’t have time to sleep eight or nine hours
a night, don’t have time to eat anything but junk food, don’t
have time to connect deeply with other people on a regular
basis. Yet many of them, on an average day, spend three hours
or more in front of the TV, the computer monitor, or the game
console. That’s a lot of time that could be put to some other
use. So they do have the time to make changes in their lives.
What they don’t have is the carrying capacity.
In 2007 researchers at the University of Kentucky found
that those who’ve just done something that requires willpow-
er—like resisting the temptation to eat a cookie—have less
willpower left for persisting in doing the next hard thing—
like solving a tough anagram puzzle. What the study shows is
that all of us have a certain capacity for taking on challenges,
but it’s limited, and the resource gets smaller and smaller as
we use it up. Just do it is something people will do only when
they haven’t already overdone it.
You may really want to make a change, but if you’re al-
ready struggling through life carrying two large suitcases
and a poodle, as most people in this society are, you won’t get
very far when you add more to your load. A history of depres-
sion reduces your carrying capacity even further, meaning
that you may have less ability than most people to pile more
challenges on. (This will change when your depression ends.
You’ll fnd that you can handle far more than you used to be
UP W ¡ T H O U T ME D S 1=q
So if you’re going to start making lifestyle changes with
any assurance of success, you’re probably going to have to
fnd a way to lighten the load you’re already carrying.
What could you drop to free up some capacity? Think
about all the responsibilities you have at work, at home, and
elsewhere, that currently weigh you down. Which of them
are less important to you than getting healthy and ending
Three words that trip people up
Frequently, when I ask someone to identify some responsi-
bilities they could shed, three words make an immediate ap-
pearance in the conversation: “but,” “have,” and “so.” These
troublesome little words show up in statements like these:
But I have to work extra hours so I won’t lose my
job in the next downsizing.
But when I have extra time, I have to spend it with
my kids so I won’t feel like a bad mother.
But I have to keep the house clean so we won’t be
living like pigs.
Do your thoughts run in this direction when you consider
lightening up on your responsibilities? If so, I’d ask you to
do some serious thinking, and maybe even discuss it with a
friend. Can you—
Free up some capacity by relaxing your standards
Use up less of your capacity meeting other people’s
TO R T O ¡ S E S R E C O V E R ¡A S T E R 1==
Reduce some of your demands on life?
Free yourself from some of your anxiety, guilt, or
compulsiveness, perhaps with the help of psycho-
therapy, spiritual work, or meditation?
Work more effciently?
Delegate some of your work?
Imagine if something were to happen that forced you to give
up some of your current responsibilities. For example, sup-
pose that, God forbid, you became partially disabled and
couldn’t handle a full load of responsibilities. You’d fnd a way
to cut back on them, wouldn’t you? Some of the demands you
make on yourself that you now see as necessary would start
to seem unnecessary, wouldn’t they?
As someone who suffers from
clinical depression, you are disabled.
Nothing could be more justifed than reducing your respon-
sibilities so you can recover from depression.
And don’t forget, when your depression ends, it will be a
blessing not just to you but to everyone around you. When
you overcome a mood disorder, you’re only one of dozens of
people who will feel better. If, for you, overcoming depres-
sion means others have to see a few more dust kitties around
your house, how many of them would feel, do you think, that
you’d made the wrong choice?
If, on your own or with help from your friends and family,
you can’t fnd a way to lighten your load so you can address
the causes of your depression, it might be time to make an
appointment with a behavior therapist or life coach who can
UP W ¡ T H O U T ME D S 1=6
help you come up with a strategy. You can also fnd a way
out of the dilemma by signing up for one of the live, personal
guidance and support options at 5decisions.com.
Once you’ve lightened your burden, it’s important to avoid
overtaxing the extra capacity that you’ve freed, which you’ll
do if you attempt too much change at once. Many depressives
are conscientious to a fault, so you might be inclined to over-
do it. But I would encourage you to make a modest frst effort
that will give you a small but reliable foundation to build on.
If you’re starting to exercise after avoiding it for a period
of time, begin with just three sessions a week, and see how
it goes. If you decide to cut back on nighttime TV so you can
get more sleep, don’t toss the set in the trash; try an hour
less every night. If diet is your initial focus, make just a few
adjustments; becoming a vegan may be overreaching at this
point. If coming out of social isolation is your frst step, fnd
one good club to join, and take it from there.
Don’t fght addiction till you’re trained for the bout
Dropping an addiction may not be the best frst step, since it’s
not something you can normally do in small increments. For
most people, giving up a serious dependency requires a big
leap. That’s why I recommend that you consider making the
leap only after you’ve built up additional strength with other
lifestyle changes, like exercise and social contact, as I did.
Put yourself on the hook
When you’re establishing a new habit, one of the smartest
things you can do is go public with it. This provides an in-
centive for you to hang in there even when you don’t want
to, by upping the cost of quitting. Going back on your word
when you’ve made a public promise is a blow to your image,
TO R T O ¡ S E S R E C O V E R ¡A S T E R 1=;
so you’re less likely to break that kind of promise. One of the
most powerful motivations—perhaps the most powerful mo-
tivation after a parent’s love for a child—is the need to look
good. Or at least to not look bad.
Rationally, it doesn’t make sense for a soldier to follow
orders knowing that obeying the orders may well get him
killed, but men (and now women) do it all the time. What
could possibly motivate someone to willingly walk into the
jaws of death? Read what one Civil War soldier wrote in his
Let the consequences be as they might, I’d rather die like
a brave man than have a coward’s ignominy cling around
my name and live. Of all names most terrible and to be
dreaded is coward.
If you’re a woman and you think this psychological principle
applies only to men and their masculine egos, imagine the
most embarrassing thing that could possibly happen to you
in public. Picture it in detail. Then think about the lengths
you would go to, the sacrifces you would make, the money
you would spend in order to keep it from happening. That’s
how much you care about not looking bad.
Or consider the fear of public speaking. Studies show that
many people are more afraid of giving a speech than they
are of death, prompting Jerry Seinfeld to crack, “At a funeral
most of us would rather be the one in the coffn than the one
giving the eulogy.” And what is this phobia, really? It’s just
the fear of looking bad in front of a lot of people.
Our desperate need not to look bad is in itself a little em-
barrassing, but it can be used as a powerful motivator when
you’re taking on a new challenge. If you tell your friends, “I’m
going to exercise three times a week—you can count on it!” the
UP W ¡ T H O U T ME D S 1=8
price of quitting just went up. At some point in the process of
making lifestyle changes, you may temporarily lose interest
in continuing, but you’ll never lose your need to avoid look-
ing bad. This deeply embedded human need can make all the
difference when you can’t fnd any other way to talk yourself
into sticking with a commitment. People tend to make more
progress when they work with a coach or personal trainer,
and one reason they do is that they don’t want to look bad in
the other person’s eyes, so they keep showing up, even when
they don’t want to.
Form a team
Everyone has his own defnition of friendship, but this is one
defnition I like:
A friend is someone who wishes you happiness
in life and feels privileged to help you achieve it.
I’ll bet you have some friends like this; if so, they can be enor-
mously helpful in keeping you on track as you make changes
in your life. Share your commitments with them, and ask
them to mention it to you if they ever see you backsliding.
This increases the stakes for you.
But be careful whom you put on your team. Many of us
have friends who neglect their own wellbeing and are full of
understanding and forgiveness when we neglect ours. They
may be wonderful friends, but overly permissive people don’t
make good team members.
In fact, just having friends who are unhealthy can be haz-
ardous to your own health. A 2007 study at Harvard Medi-
cal School found that when an individual becomes obese, it
triples the chances that her closest friend will also become
obese. On the other side of the coin, when one member of
TO R T O ¡ S E S R E C O V E R ¡A S T E R 1=¤
the pair loses weight, it increases the chances that her friend
will, too. This is not to say that social considerations are the
most important factor in weight gain or loss—it’s more com-
plicated than that—but does underline the fact that peer in-
fuence has a lot to do with how we conduct our lives.
If you don’t have friends whom you feel you can count on
for support, consider getting yourself a life coach or behavior
therapist. Joining a support group can be a great way to make
sure you stick to your plans, too. Or sign up for live, personal
guidance and support at 5decisions.com.
After you’ve anchored a change into your life as a new
habit, it will start to seem fairly automatic, and won’t feel so
much like forcing yourself to do it every time. At that point,
it’ll be time to think about the next change you want to make.
You’ll know when that time comes, and you’ll also have a
sense about what the next change should be. If you’re pa-
tient and don’t go too fast, you’ll fnd that as you take on each
new challenge, you’ll proceed with confdence and strength,
thanks to all the changes you’ve already made.
If you have an addiction, keep checking in with yourself,
as you make step-by-step changes, to see if the time has come
to quit. Because every positive lifestyle change you make
strengthens your neurotransmitter system, each one helps
pave the way for recovery from any form of addiction. It’s
been proven that correcting defciencies in exercise, sleep,
good nutrition, and social contact even helps people give up
compulsive gambling and shopping. But only you can know
when the moment has come. If you’re not ready, don’t worry
about it. Keep making the changes that weaken addiction’s
hold on you, and your addiction will drop away as soon as it’s
no longer of any use to you.
Getting back to the present, my wish is that when you
close this book now or a few minutes from now, you’ll get to
UP W ¡ T H O U T ME D S 16o
work on your recovery right away. I’d like you to think about
it, sleep on it, and then tomorrow, decide which frst step
you’re going to take. Before you go ahead and take it, I hope
you’ll increase your chances of success by shedding some ev-
eryday responsibilities that would weigh you down and hurt
your chances of sticking with it. And then, when you’ve freed
up enough carrying capacity, you’ll be all set to take that frst
step. I’m confdent you can get this done before another week
goes by, and if you do, you’ll later look back on these few days
as among the most important ones ever on your road to hap-
piness and wellbeing.
T W E L V E
be C o m i n g un s i n k A b L e
I ma g i n e a d r u g t h a t c o u l d p u l l y o u o u t o f
d e p r e s s i o n wh e n e v e r y o u s t a r t t o g o u n d e r .
Yo u r b o d y ma k e s a h a l f - d o z e n o f t h e m.
f you go to my website, upwithoutmeds.com, you’ll fnd a
blackboard that shows how long it’s been since I was last
depressed. Check it out, and you’ll see that it’s been years
since my last episode. Look again ten years from now, and
it’ll show ten more years of depression-free days. The num-
ber on the blackboard will keep going up for as long as I live,
because depression is out of my life for good.
How can I be so sure? Well, for one thing, I know I’ll keep
taking my own advice and continue to maintain my buoyancy
through regular exercise, suffcient sleep, and the other good
habits that protect me against depression. Since I’ll be giving
my body the daily care it requires, my biology will have no
need to lodge a complaint in the form of depression or some-
thing even worse, like heart disease. Oh, I may come down
with something or other by the time you’re reading this book.
I may even be dead. After all, I’m 65 as I write this, and may
be much further along in years by the time you get around to
reading it. But if I do become ill, it won’t be because of self-
neglect. And whatever I fall prey to, it won’t be depression.
My daily routine gives me even more immunity than the
33 percent of the population who carry two anti-depression
genes. But even this protection could be breached by an un-
accustomed load of stress. If that happens, I’ll still be un-
sinkable, because I have a self-rescue technique that keeps
me from going under, no matter what happens.
UP W ¡ T H O U T ME D S 16z
I don’t recommend you try this technique until you’ve
built up your everyday buoyancy by adopting the lifestyle
changes that I’ve discussed in previous chapters. Without ad-
equate neurochemical conditioning as well as a foundation of
good lifestyle habits, self-rescue won’t work for you as well as
it does for someone who is in reasonably good shape before
The lifestyle changes that I’ve talked about in previous
chapters have to do with prevention—how to decrease the
chances of a future episode by providing for your body’s needs
today, tomorrow, and beyond. Over a period of months, the
changes increase your emotional buoyancy by putting back
in your life necessities that modern living takes away. But
what do you do, in spite of all the protection you’ve built up,
if a breach should occur and you start sinking?
Suppose the drug companies offered a product that could
interrupt a spiral. This type of drug is not unheard-of for
some conditions. It’s known as a rescue medication. For ex-
ample, in addition to anti-infammatory drugs that decrease
the likelihood of future asthma attacks, there are broncho-
dilators that halt an ongoing episode by quickly expanding
swollen air passages. An asthmatic never goes anywhere
without his bronchodilator, because he knows it could save
his life by rescuing him from an oncoming attack.
A rescue drug for depression?
If there were such a drug for depression, it would surely be
a top seller. But there isn’t one. This means that if an epi-
sode starts coming on, you’re sunk. All you can do is muddle
through and wait for the demon to be done with you.
However, there is a leading nonproft pharmaceutical con-
cern that produces a half-dozen drugs that can pull you out
of depression. They include the fast-acting antidepressants
B E C O M ¡ N G UN S ¡ N K A B ¡ E 16¤
serotonin, norepinephrine, and dopamine, plus some others
that aren’t as well-known. The cutting-edge technological en-
terprise that produces them? Your own body.
Not only can your own bodily processes prevent future
episodes of depression more effectively than any drug sold
as an antidepressant, as we’ve seen in previous chapters, but
these processes also have the ability to halt an oncoming epi-
When you need to pull out of depression, you access these
drugs by doing two things we’ve already talked about—but
doing them in marathon style. They are exercise and mean-
ingful social contact. A few hours, a full day, or, in the worst
case, a few days of steady physical exertion combined with
the right kind of social contact is all it takes. No matter how
badly your brain chemistry is stuck in reverse, you can al-
ways turn it around and get it going in the right direction by
a prolonged focus on these two activities. Depression simply
cannot sustain itself when you immerse yourself in these ac-
tivities, because they continuously bathe your brain in an-
tidepressants so powerful, no drug company could legally
Two more rescue tools
There are two additional items that may belong in your res-
cue kit: meditation and prayer.
Like exercise and social contact, a regular regimen of
meditation or prayer has the long-term effect of protecting
you against a future episode of depression by building up ev-
eryday protection against depression. But because they both
release fast-acting antidepressants into your blood almost
immediately, these activities also provide rescue medication
in a depression emergency. I didn’t discuss them in the chap-
ters on prevention, because I believe, for all the conditioning
UP W ¡ T H O U T ME D S 16q
power they offer (in addition to their spiritual benefts), they
aren’t essential for physical or mental health. I know quite a
few people who are in fne shape without them. Conversely,
I know others who meditate or pray regularly, yet are de-
pressed, unhealthy, or even addicted.
From a health standpoint, I like to think of meditation
and prayer as advanced prevention methods for people
who’ve already met the requirements of regular exercise, suf-
fcient sleep, good nutrition, meaningful social contact, and
freedom from addiction. Similarly, in a depression emergen-
cy, they can never be more than supplements to exercise and
social contact. For rescue, I wouldn’t recommend them at all
unless you’re experienced with them, because, if you’re not,
they can turn into a rumination on your problems, and that
wouldn’t be productive.
Let’s assume you’ve built up your buoyancy to a normal
level by making the changes in your life that I recommend in
previous chapters, but then something comes along that sub-
jects you to unusual stress, and you start getting depressed.
If you’ve conditioned your mood-recovery system by follow-
ing the recommendations in this book, you’ll fnd that when
your mood starts to go downhill, it doesn’t take a whole lot
of exercise and social contact to reverse the slide. A physical
workout, some quality face time with a friend, or an hour of
open-hearted social service may do it.
But suppose you do one or two of these things and your
depression recedes, but then comes roaring back soon after-
ward. If that happens, you keep yourself moving and social-
izing until depression departs for good. If you stick with it,
you’ll fnd it doesn’t take long to restore your normal mood.
B E C O M ¡ N G UN S ¡ N K A B ¡ E 16=
Don’t be spontaneous
When you’re dealing with depression, it’s always important
to have a structure rather than relying on yourself to do the
smart thing spontaneously, because when you’re depressed,
what you do spontaneously is nothing. So you need to pre-
pare ahead, before it becomes necessary to rescue yourself
from an episode, by taking these three steps:
Make sick-day arrangements
Write a sick-day script
Let’s look at each step in detail.
When you’re recovering from an appendectomy, your body is
unlikely to respond to a part-time effort. For example, sup-
pose after surgery you stay in your hospital bed for a couple
of hours, then get up and get dressed to go out to a business
meeting. After the meeting, you come back and put on your
hospital gown for a little while, then jump out of bed again for
another appointment. No doctor would allow this, because it
would, at best, delay the recovery. Chances are, your condi-
tion would just get worse.
Your body demands no less devotion when you’re fghting
off an episode of depression. A part-time effort simply won’t
do it. Your recovery may not take long—as little as an hour
or two—but until you’ve got your buoyancy back, you can’t
afford to divide your efforts. You’ve got to be single-minded,
just as you would be when you’re recovering from surgery.
This means clearing your schedule of all your normal obli-
UP W ¡ T H O U T ME D S 166
gations, and asking others to temporarily take over your re-
sponsibilities. I know you can do this if you decide to, because
it’s exactly what you will do if you ever go into the hospital for
an emergency appendectomy.
“Sorry, but I can’t make it today”
When you notice the frst symptoms of a developing spiral,
you bail out of your normal life and declare a sick day. Just as
you would if you were in the hospital, you ask people to give
you a full pass on all of your responsibilities, perhaps telling
some that you have the fu, and others, those who are closer
to you, the truth. You let everyone know that you’ll be out of
commission for a short time. You ask some people to take
over your responsibilities temporarily.
Asking others to shoulder your load may be a bit harder
for you to do than it would be if you had an attack of appendi-
citis. You may feel justifed in letting them take over for you
when you’re laid up in the hospital, but less justifed when it’s
“just” a mood that’s got you down. But remember, you don’t
choose depression any more than someone chooses a rup-
tured appendix. And depression can be just as serious. It can
encourage the onset of deadly conditions like heart disease,
stroke, Parkinson’s disease, and Alzheimer’s disease. And it
is implicated in the majority of more than thirty thousand
suicides that occur in the U.S. each year. So you have all the
justifcation anybody could ever need to devote yourself fully
to recovery from depression, while allowing others to take on
some of your duties during this brief period.
When you get depressed, you may appear to be more or
less functional, so it could seem to the people in your house
that everything is fairly normal. This means no one is neces-
sarily going to offer to start picking up the balls that you need
to begin dropping. So you have to make plans in advance.
B E C O M ¡ N G UN S ¡ N K A B ¡ E 16;
Picture going to the hospital
Begin by imagining in detail what would happen if you were
rushed to the hospital for an emergency appendectomy. If you
have a job, who would call your boss to say you’re not coming
in? Who would cover for you at work? If you’re married, what
tasks would your spouse assume? If you have children, who
would take care of them? If there are appointments on your
calendar, who would cancel them? If you’re the cook, who
would assume that responsibility? If you’re the one who pays
the bills, who would see that the checks get mailed?
Make a written list of all your daily responsibilities. Next
to each item, write down the name of the person who would
substitute for you if you were rushed to the hospital. Then sit
down with each person on the list and work out the details.
If you would prefer that some people on your list not know
they’re helping you plan for an episode of depression, tell
them you’re setting things up in case you come down with
the fu or decide to go in for elective surgery.
If you feel comfortable discussing your depression with
others on the list, let them know that in asking them to take
over your responsibilities briefy, you’re giving them an op-
portunity to help you overcome your depression. Explain
that taking a day off isn’t going to be about indulging yourself
and just kicking back when you don’t feel like doing anything.
The point of shedding your normal responsibilities is to make
the time available to work your behind off in an effort to end
your depression as quickly as possible.
People want to help you
If you share with them some of the information about de-
pression that I’ve presented in this book, and you describe
the script we’re about to discuss and how it works, it’s likely
UP W ¡ T H O U T ME D S 168
that the individuals you’re depending on will be happy to
support you. In talking with people who have a depressed
person in their life, I fnd that most of them suffer vicari-
ously, and would do almost anything to help their loved one
get free of their suffering. If you’ve been having episodes for
a number of years, the people around you probably feel as
helpless about it as you do. They’ll welcome the opportunity
to do what they can to help you win one for the home team.
If you live alone and mostly provide for your own needs,
promise yourself that if and when depression starts to come
on, you’ll drop everything (or almost everything) so you can
devote yourself to recovery. This means letting all housekeep-
ing and home maintenance tasks slide, unless there’s a true
emergency; canceling all social obligations (except those that
ft the script); and postponing everything else that can pos-
sibly be postponed. Resolve to do only the basics required for
personal hygiene, plus eating. Plan some light meals that you
can prepare quickly, without going food shopping—things like
warmed-up leftovers, scrambled eggs, peanut butter sand-
wiches, quick oatmeal, cheese and fruit, and tuna salad.
Eat and run
Whether you have help or you’re alone, minimize the time
you spend at meals, unless you’re having a meal with a friend
who lifts your spirits. Do no more than is necessary to keep
yourself fed. But avoid prepared foods and fast food, and es-
pecially sugary foods that would give you a fy-now, pay-later
boost. (See Chapter 4.) If you go to a restaurant, order the
lightest, most healthful items on the menu. Skip dessert. And,
unless you’re eating with a morale-boosting friend, choose a
place where you’ll be able to eat quickly and run. Unlike most
sick days, this one is going to keep you busy—too busy to lin-
ger over meals.
B E C O M ¡ N G UN S ¡ N K A B ¡ E 16¤
Now let’s talk about what you’re going to be doing with all
the free time you’ve created.
Your script is a detailed schedule of mood-elevating activities
that, except for necessary food breaks and hygiene needs,
will occupy you until the depression lifts for good. By writing
a script before you get depressed, you’ll know exactly what to
do if depression starts to come on. When the time comes, you
won’t have to make any decisions. You’ll just get out the sheet
and follow the directions.
When you create your script, combine your antidepres-
sant activities any way you want, but stick to the tasks that
provide quick depression relief: exercise and meaningful so-
cial contact (and, if you have the skills, meditation or prayer).
Here are some tips about writing the script:
Write it out in detail, using the sample below. Keep
your completed script someplace where you can
fnd it when you need it. Don’t cheat yourself by try-
ing to commit your plans to memory. By going to
the trouble of putting the script in writing, you’re
insuring that you’ll know what to do when the time
comes, and you’re dramatizing your commitment
to yourself, a good self-psychology technique. The
less casual you are about this now, the more resolve
you’ll have at the decisive moment, when depres-
sion will be urging you to stay on the couch or un-
der the covers, instead of getting up and doing what
needs to be done.
Plan exercise sessions to last at least thirty minutes
each, preferably more. But don’t overdo it. Stick to
UP W ¡ T H O U T ME D S 1;o
forms of exercise that are already in your reper-
toire, and don’t create a schedule that would exceed
your current physical limits. If you’ve been exercis-
ing regularly to build up your long-term buoyancy,
you’re probably in good enough shape to handle
moderate exertion for at least several hours over
the course of the day, breaking it up into two or
more separate sessions. But you’re the best judge of
this. Plan to work hard, but be sensible.
If you haven’t been exercising regularly, I recom-
mend that you put off using the techniques I cover
in this chapter until you get into better shape by
adopting a program of regular exercise, suffcient
sleep, and the other changes discussed in previous
Have a Plan B to overcome impediments. If you in-
tend to walk outdoors and there’s a storm, what will
you do—put on rain gear? Walk in the mall? Get on
your exercise bike?
When other people are involved, what is your alter-
nate plan if they can’t make it? For example, if your
script calls for you to play tennis with Susan but
Susan cancels, who can you call instead? If “cof-
fee with Frank” is in your script because Frank is a
friend who lifts your mood, what happens if Frank
is out of town? Is there someone else you could
have coffee with who has a similar effect on you?
If not, what could you do that doesn’t depend on a
friend’s availability? For example, you might spend
a couple of hours visiting people at a hospital or
B E C O M ¡ N G UN S ¡ N K A B ¡ E 1;1
If all else fails, drop in on a local Alcoholics Anony-
mous or other 12-step meeting. You can go as a guest
observer, even if you don’t know anybody there and
are not yourself an addict. (Some meetings are
closed to guests, but most aren’t.) You don’t have
to stand up and speak if you’d rather not, but, if my
guess is correct, your heart will be touched by the
sincere frst-person accounts of both struggle and
triumph that you’ll hear at any of these meetings,
and your body and mood will respond positively as
the negative neurotransmitters of depression are
replaced by the positive chemistry of compassion.
You shouldn’t have any trouble fnding a meeting
that fts your scripted schedule. Every town of any
size has dozens of meetings a week. A small city
has dozens every day, from early morning till late
at night. Your local paper may list meeting times
and places, or check the link for AA listings at
You get an extra antidepressant boost when you
combine exercise and social contact. Hiking with a
group, weight-training with a partner, playing on a
volleyball team, working out in an aerobics or yoga
class—they all give you a double dose of good brain
UP W ¡ T H O U T ME D S 1;z
M y S c r i p t
Time Activity Alternative Plan
6:00 a.m. Shower and shave (same as always)
6:30 a.m. Email my hiking buddies, inviting any
who are available to go out on the trail
with me this morning
6:45 a.m. Meditation group (same as always)
8:00 a.m. Breakfast with Judy (same as always)
8:45 a.m. Phone calls to arrange lunch with one of
several close friends who lift my spirits
9:00 a.m. Hike my favorite trail, either by myself
or, if I’ve had any takers from my email,
with one or more hiking buddies
Rain gear in case of a storm.
Snow shoes in winter.
Noon Lunch with whoever accepted my invita-
tion during the 9 a.m. calls
If no one is available for
lunch, call close friends on
the East Coast, where it is
two hours earlier. Grab a
1:30 p.m. Visit nursing home
3:00 p.m. Workout with exercise DVD
4:30 p.m. Meditate at home
6:00 p.m. Dinner with Judy
7:00 p.m. Write emails to friends with the purpose
of making them feel loved and appreci-
9:00 p.m. Bed
When you fall into depression, it’s normal to experience a
strong aversion to doing the very things that will pull you out
of the depression. When your mood starts to plummet, your
B E C O M ¡ N G UN S ¡ N K A B ¡ E 1;¤
instincts are the same as when you come down with the fu.
Everything in you tells you to crawl into a cocoon and do as
little as possible. This is the right thing to do when you have
the fu, but the wrong thing to do when you’re depressed. But
you’ll want to do it anyway.
Unless you’re exceptionally strong-willed, you may not be
able to count on yourself to resist depression’s seductive ar-
guments for staying on the couch or under the covers. That’s
where family and friends can make all the difference. If you
tell them about your sick-day plans in advance, and ask them
to support you if and when the day comes, they’ll be there to
encourage you when you’re having a hard time persuading
yourself to get moving.
Finding good support
Some people will be more helpful than others. Limit your
support group to those who aren’t afraid to challenge you
and aren’t susceptible to being manipulated by you. People
who’ve overcome addictions or other diffculties themselves,
and know it can be done, can be especially helpful. You may
fnd that it’s best to set things up so different members of
your anti-depression team play different roles. For example,
if your spouse is sensitive to your moods but doesn’t feel com-
fortable nudging you to keep your commitments when you’re
balky, you might have an agreement that he or she will call
your best friend, whose job it will be to support you.
If you don’t have a circle of friends with support skills, or
you prefer more structured support, or you want to protect
your privacy, you can sign up for one of the live, personal
guidance and support options at 5decisions.com.
Now let’s review the whole rescue plan.
UP W ¡ T H O U T ME D S 1;q
Declare a sick day, relying on the same emergency
backup system that would kick into gear if you were
rushed to the hospital. This frees you from all of
your normal responsibilities for several hours or a
day or two—however long it takes for you to recover
Adjust your script to include any anti-depression
activities, like lunch with a close friend, that you
were planning to do today anyway, before you
started getting depressed.
Call for any support you need from friends and
family in order to keep your commitment.
Begin following the script.
Monitor your mood. When you feel normal again,
discontinue the script, but keep an eye on how
you’re feeling. If depression comes back, return to
the script. Stick with it until depression is gone.
Here are a few more tips:
When depression starts to come on, don’t postpone
dealing with it, hoping to get caught up on normal
tasks before you declare a sick day. The longer you
wait, the more entrenched the depression will be-
come, and the more time and effort it’ll take to dis-
Don’t go to work, even if staying busy at work nor-
mally provides some buoyancy. Don’t divide your
efforts. Devote yourself fully to recovery.
Avoid at all costs the kinds of things that people of-
ten turn to when they get depressed, including TV,
B E C O M ¡ N G UN S ¡ N K A B ¡ E 1;=
the Internet, video games, reading, movies, alcohol,
drugs, sweets, pornography, and recreational sex.
Rather than following the instinct to hide out or try
to jack up your mood using self-defeating shortcuts
like alcohol, drugs, or shopping, stick to the activi-
ties that can prime your mood-recovery system to
bring back your buoyancy naturally.
Try not to obsess about any negative situations that
initially upset you and led to your depression. Don’t
spend a lot of time talking with your friends and
family about what’s wrong. Focus on what you’re
doing at the moment—the exercise, the warm con-
versation, the meditation, the prayer. But even if
your thoughts do get stuck in the wrong place, re-
member that your mind, no matter how dysfunc-
tional temporarily, doesn’t have the power to keep
you depressed. Only inaction does. So if you can’t
help it, go ahead and think whatever you’re think-
ing. But keep working that body.
Deterrent power against depression
When you prove to yourself that you can rescue yourself from
depression, it will do wonders for your self-confdence. You’ll
fnd that you’re like a protagonist in the movies who’s always
been mocked and humiliated by powerful people, but then
turns the tables on everyone and winds up on top. This role-
reversal, in which you turn the tables on the mood disorder
that has always dominated you, will do so much for your mo-
rale, it’ll have a healing placebo affect on you. Together with
regular exercise, suffcient sleep, and the other habits that
maintain normal buoyancy, discovering that you’re in control
UP W ¡ T H O U T ME D S 1;6
of your own mood may be all it takes to keep depression away
from you for good. During the Cold War, they called it the
theory of deterrence: Having nuclear capability, the thinking
went, means never needing to use it. In the same way, know-
ing there’s a sheet of paper in your desk that tells you step
by step how to rescue yourself from depression may mean
the sheet will forever gather dust in the drawer. With your
new confdence, depression may never pick a fght with you
But if it does, we already know who the winner will be.
T H I R T E E N
yo u We r e bo r n
to be bu o y A n t .
De p r e s s i o n c a n’ t t a k e r o o t i n a we l l - t e n d e d l i f e .
epressives are famous for feeling hopeless, and may-
be one reason is that for fve thousand years, the ex-
perts on depression have been giving us hopelessly
Ancient depressives were told by the experts that devils
had entered them. Since there were actually no devils in-
volved, exorcism was no cure, and the situation remained
Depressives of Hippocrates’ time were told by the experts
that they had black bile in their blood. Since black bile was
nonexistent, drawing blood didn’t cure anything, and the
situation remained hopeless.
Depressives of the Middle Ages were told by the experts
that their disease was punishment for their sins. Since sin
has nothing to do with depression, virtue was no cure, and
the situation remained hopeless.
Depressives of more recent times have been told that their
disorder is caused by genes, childhood conditioning, distort-
ed thinking, stress, and now, above all, an inherent chemical
imbalance. Since all of these factors play only a supporting
role in depression and are not decisive, our weak attempts to
correct or compensate for them are no cure, and the situation
In fact, the situation is far from hopeless, but only when
reality isn’t being defned by the experts and their off-the-
UP W ¡ T H O U T ME D S 1;8
We now have sixty years of data that point to the decisive
factor in depression and thus its real cure. With depression
doubling in every American generation during these six de-
cades, it becomes obvious for the frst time that the chief cause
of the disorder isn’t any of the monsters in the traditional
bestiary. The devils dreamed up by the experts, whether they
take the form of winged creatures, dark humors in the blood,
or pernicious brain chemicals, are indeed diabolical. But it’s
not because they have any ultimate causal power. It’s because
they’re red herrings that distract us from realizing what the
decisive factor in depression really is.
With science comes bad science
When Western science was born, it didn’t emerge from the
womb alone, but entered the world with an evil twin: pseudo-
science. Pseudo-science is no less delusional than the fearful
superstitions, ungrounded speculations, and crackpot pieties
of our ancestors, but because pseudo-science trades on the
integrity and credibility of modern science, it has the same
power to mislead us today as a guy shaking rattles in a cave
had in his time. However, unlike the poor depressive of the
past who had nobody to turn to but the shaman, philosopher,
or priest, you and I have an alternative to voodoo medicine,
because pseudo-science, for all the billions spent to promote
its false ideas in drug-company ads, doesn’t own a monopoly
on information. Today we can turn to real science for a real
cure. We can look at the research data—the vast quantities of
hard-won, indisputably valid information compiled by inde-
pendent researchers—and make up our own minds.
The scientifc data compiled during the last sixty years
tell us that depression has multiple underlying causes, the
most important of which is something most of the experts
consider not important enough even to mention: the way you
YO U WE R E B O R N TO B E B U O Y A N T 1;¤
live. We have abundant epidemiological evidence showing
that the rise in depression has paralleled simultaneous rises
in physical inactivity, sleep deprivation, nutritional reckless-
ness, social isolation, and addiction. We also have inductive
evidence from hundreds of studies showing that when you
correct any of the fve lifestyle defciencies endemic to mod-
ern life, depression recedes, a strong indication that lifestyle
defciencies are the decisive factor in depression. As a fnal
confrmation, we have groups of people, notably the Amish,
who have avoided these same defciencies and who, as a con-
sequence, suffer low rates of depression.
Fact provides more hope than fantasy
The story told by all this data is both more accurate and
more encouraging than the one being put forth by most of
the experts. The experts are telling you that your depression
is caused by conditions over which you have little or no con-
trol and over which the experts themselves have little or no
control—your genes, childhood experiences, cognitive style,
personality factors, and abnormal brain chemistry. In effect,
they’re telling you that you were born to be depressed. But
science is saying that the decisive factor in your depression is
the one over which you have complete control: the decisions
you make about the way you live.
Science is saying that you get depressed not because there
is anything inherently wrong with you, but because you’ve
made a few poor choices. It’s saying that you were born to be
buoyant. And it’s saying that you can reclaim this birthright
anytime you want to, because depression has no place to take
root in a well-tended life.
UP W ¡ T H O U T ME D S 18o
Societal change fosters depression,
personal change ends depression
Today’s Americans are more depressed than people have
ever been because rapid change has negatively impacted the
way most of us live our lives. But the other side of the coin is
that today’s Americans handle change better than perhaps
any population in history. We’ve had to learn to be virtuosos
of adaptation, because life since we were born has evolved
so fast, we’d be left in the dust if we couldn’t make constant
If you look back over your own life, I’m sure you can re-
call dozens of changes you’ve made in your life over the years
that, cumulatively, would have staggered your grandparents.
They probably wouldn’t have been able to make the changes
you’ve made. And now I’m telling you that you can use this
most modern of all abilities—the capacity to change—to over-
come the most modern of all affictions. If you put back in
your life the necessities that modern living has taken away,
you’ll fnd out just how healthy and happy you can be.
You’ll fnally discover just how healthy and happy you
were always meant to be.
F O U R T E E N
f u r t h e r he L P
My we b s i d e o f f e r s a we a l t h o f r e s o u r c e s
f o r e n d i n g y o u r d e p r e s s i o n
o r h e l p i n g s o me o n e e l s e e n d t h e i r s .
At 5decisions.com you’ll fnd all this:
Help starting out
Personal, one-on-one telephone coaching to get
you started off on the right foot
A free buddy program that matches you with a
compatible “tele-pal,” who’ll support you in mak-
ing changes in return for your support
A telephone support group that meets weekly
to put group dynamics to work for you while pro-
tecting your privacy
A local support group in your area
Support materials and special events
Workbooks, guides, tests, live workshops,
and teleseminars to speed you on the road to
UP W ¡ T H O U T ME D S 18z
Tailored guidance for at-risk groups and special cases
Special help for women, men, young people, ad-
dicted individuals, and people over 60
Guidance for helping a depressed person recover
Materials to help you educate someone about
the true cause of his or her depression, and guid-
ance on providing support for the changes
they need to make
Information and training for professionals
Help for integrating the lifestyle approach
to recovery into your practice if you’re a psy-
chotherapist, physician, life coach, wellness practi-
tioner, or personal trainer
A corporate program
Ways to integrate the lifestyle approach to recov-
ery into your company’s wellness program
A program for health clubs
An exercise- and yoga-centered program to
help your members overcome depression
Talks to your group
Lively, interactive presentations that show
audiences how to end their depression by making
fve lifestyle decisions
I n d e x
5 Mile Island 88
5decisions.com 12, 29, 46, 70, 78, 96,
104, 115, 132, 140, 146, 156, 159, 171, 173,
Accident proneness 2
see also alcoholism
Amish immunity to 43
blackmailing dynamic of 133
choice in 144
damaging effects to lifestyle of 139
depression’s synergistic relationship
with 36, 133
enouraging statistics on recovering from
flling needs in ways other than 146
food 111, 139
high rate in America of 3, 138
hitting bottom in 143
loan-shark dynamic in 133
negative effects on lifestyle of 136
plan for 142
preparatory work in 146
role of exerise in 76
struggle isn’t necessary in 142
social aspects of 139
vulnerability of depressives to 134
War Generation relatively free of 40
Addictive habits 141
Ads, drug-company 178
effect on doctor behavior 27
Agave nectar, blue 19
Alcoholics Anonymous 144
deifcation of addiction in 143
directory of meetings for 171
and self-selection 142
as a way to socially connect 131
acknowledging feelings of helplessness
choosing for or against 143
depression’s synergistic partnership
my own painless recovery from 17, 20-1
recovering on your own from 145
importance of self-selection in 142
role in ending depression of 38
cholesterol as a factor in 105
depression’s link to 2, 166
role of exercise in preventing 75
capacity for change among 180
high rate of depression among 180
American Academy of Sleep Medicine 93
American Diabetes Association 60
American Medical Association 48, 51, 74
American Sleep Foundation 94
Amish 42-3, 67, 179
Anchoring habits 159
addictive properties of 62
cost of 59
dangers of 59, 60
distorted results in trials of 54
efforts to conceal the poor results of 52
hazards of long-term use of 60
ineffcacy of 48
lifestyle changes more effective than 13
mistakes doctors make in prescribing
other medications interact dangerously
percentage of Americans taking 48
placebo effect of 11, 54
poor performance of 47, 53-4, 57
a recommendation to stay on 11
side effects of 58
unknown dangers of 61
unpredictability of 50, 58
Anxiety 58, 62, 90, 136, 155
Apnea, sleep 92-3
Archer Daniels Midland 99
Bad Bulb Test 36-7
Beck Depression Inventory 44
Beliefs, the power of 53-4
Berkeley, University of California at 73
Bessemer-process steel 33
Beth Israel Medical Center 51-2
Big Mac 111
UP W ¡ T H O U T ME D S 18q
pressure, effect of sedentary lifestyle
effect of exercise on 83
permanent effect of high-GL foods on
Bone density, antidepressants’ effect on
Boomers, poor health of 46
Boston University 73
Bristol-Myers Squibb 63-4
Brookhaven National Laboratory 102
Buddy program, support provided by 181
Burton, Robert 69, 70
Cacioppo, John 118
California, University of 25, 73
depression’s relationship to 2
escalating rates, U.S. lifestyle’s impact
exercise’s positive effects against 75, 89
Cannon, Walter 32
Canola oil 107
Carbohydrates 40, 102, 135, 138
deterioration, social isolation’s negative
effect on 118
health, exercise’s positive effect on 83
Carrying capacity, lifestyle changes pre-
vented by limitations on 153
Challenger disaster, sleep deprivation a
factor in 88
Charing Cross Hospital 48
Chemical imbalance, the myth of 26
Chicago, University of 25, 88, 118
Childhood conditioning, depression’s link
to 4, 31, 35, 66, 70, 177
Cholesterol 20, 105, 107, 110
depression’s link to 104-5
fats and 106-7
Clinical trials 53-4, 56, 58
Clinton, Bill 87
Coach, personal 82
Cohen, Sheldon B. 74
Connecticut, University of 52-3
Coontz, Stephanie 123
Dairy products, saturated fats in 107
clinical, defnition of 12
collapsed homeostasis in 34
hereditary factor in 35
relationship with addiction 136-7
sleep deprivation an unleashing factor
Donne, John 118
Drug companies 26-7, 32, 45, 47, 50-3,
64, 135, 162-3
Duany, Andres 120
Eating defensively 109
increasing enjoyment of 80
paying attention to subjective experience
during 79, 80
planning for obstacles in 82
positive reinforcement for 80
pulling out of an episode with 163
in addiction treatment 139
in diabetes treatment 151
as a sleep aid 94
socializing combined with 171
walking one of the best forms of 82-3
Exxon Valdez accident, sleep deprivation a
factor in 88
Farmers’ markets 115
Fast food, depression’s link to 98
Fats, categories of 40, 106-7, 110
FDA 52-3, 56, 59, 60, 64, 95, 108
File drawer effect 52
Fish, reducing depression by increasing
consumption of 38, 69
Flour, white 102-3
harmful and healthful 19, 100, 102-3,
111-2, 114, 152, 168
Food and Drug Administration 52, 58
Freedom of Information Act 52
Freud’s depression 65, 68-9
Frontal lobes, exercise’s benefcial effect
Furniture Factor 36
Gambling and depression 6, 41, 139, 141
¡ N D E X 18=
Genes 1, 4, 5, 10, 13, 34-6, 85, 149, 161,
Geneva Conventions, American lifetyle
defned as torture under 6
Glucose 98, 100, 106
Glycemic index 102
Glycemic load 101-3, 106
Gottleib, Elaine 138
Guskiewicz, Kevin 71
Haig, Scott 50
Hall, Edward T. 119
Hamilton Depression Scale 44-5, 56, 62
Hanks, Tom 117
Harvard 15, 25, 38, 48, 73, 108, 114
Harvard Medical School 82, 88, 158
Harvard School of Public Health 108, 113
foods, warning about 114
cholesterol and triglycerides as causes
depression’s relationship to 2, 105, 166
deprivation 89, 94
and trans fats 108
and the Western diet 110
Henry Ford Sleep Disorders Center 86
High-fructose corn syrup 97
Highway Traffc Safety Administration
Homeostasis 7, 32-4
Hydrogenated oil 106-7
Illinois, University of 125
Inert, defnition of 53
antidepressants’ link to 58
depression’s link to 95
exercise as a treatment for 75
statistics and tips 91
Institute of Medicine 52, 60
Insulin, high-GL foods’ effect on 106
Internet 10, 39, 41, 91, 122, 139, 141-2, 175
depression’s relationship to 25, 118, 179
help in overcoming 132
modern technology’s role in 8
tips for reducing 156
Jacobs, Jane 121
Jewish Hospital in Cincinnati 105
Kentucky, University of 153
Kirsch, Irving 53, 56
Leno, Jay 87
Leuchter, Andrew 59
decisions 11, 25, 182
habits 66, 162
mistakes 2, 3, 179
trends 4, 46
Lilly, Eli 58
Loan sharks, chemical 101, 133, 140
Marijuana 133, 135, 137-8
Marriage 66-7, 124, 146
Marx, Karl 130
Maslow, Abraham 119
Mayo Clinic 25, 73
McDonald’s 99, 112
McGill University 60
McLean Hospital 74, 138
Media, role of in depression 27
Mediterranean diet 110
Miami, University of 142
Michigan, University of 38, 71
Michigan State University 55
Missouri, University of 151
Mofftt, Terrie 35
Moncrieff, J. 48
Mood regulation as homeostatic system 8
Mood-recovery system 141, 175
Moral character as a poor explanation for
Mothers 14, 23, 44, 60, 152
Mumford, Lewis 120-1
Myers, Judy 16, 80
National Academies of Science 60
UP W ¡ T H O U T ME D S 186
on Aging 46
Alcohol Abuse & Alcoholism 136, 142
of Mental Health 65, 136
National Institutes of Health 46, 53, 59
National Longitudinal Alcohol Epidemio-
logic Survey 145
National Sleep Foundation 37, 85, 88-94
National Survey Drug Use & Health 144
Neurotransmitters 133-4, 136, 139, 141,
NFL retired players who get depressed 71
Nicotine, depression’s link to 136-7
Norepinephrine 133, 163
Nutritional recklessness in the U.S. 3
Obesity as a contagion 158
Occupiers of consciousness 140
O’Connor, Richard 65
Old age, sleep problems in 89, 94
Omega-3 acids as antidepressants 38
Panic attacks, antidepressants as a trigger
depression’s link to 2
exercise as a preventive for 75
Paxil 53, 58
Peanut oil 107
Peer infuence in habits 159
Pennsylvania, University of 46, 125
Penn State 111
Perlis, Michael 90
Personal trainers as depression-stoppers
Pharma babes 27, 50
Physical inactivity, depression’s relation-
ship with 138, 179
Physicians 1, 11-2, 20, 26-7, 45, 48-52,
54-5, 58-9, 62, 64-5, 93-4, 165, 182
infuence of drug reps on 50
Placebo 53-4, 56, 65 see also sugar pill
effect in antidepressants 11, 54
Plater-Zyberk, Elizabeth 120
Pollan, Michael 18, 25, 109-11
Post Traumatic Stress Syndrome 13
Prescription drugs, addictive 41
Prevention methods, advanced 164
Prozac 15, 53, 58, 74
Psychological explanation for depression
Putnam, Robert D. 122, 124
Pyramid of needs, Maslow’s 119
the hard step in 147
outside a program 145
lifestyle changes 159
without a struggle 146
the frst step in 160
the story of my own 15
when living alone 168
your right to ask for help in 166
Religion as a provider of emotional rich-
ness to fght depression 130
plan for pulling out of depression 173
Resistance training as an antidepressant
Restless legs syndrome as a factor in
Restless Legs Syndrome Foundation 95
Retired athletes, depression common
Robinson, Sir Ken 69
Rochester, University of 90, 143, 145
Roth, Thomas 86
Royal Edinburgh Hospital 38
Saffo, Paul 72
Scientifc method 25, 38
Score, daily GL 104
Script, sick day 165, 168-70, 174
Seafood, reducing depression with 113-4
Seinfeld, Jerry 157
Selective serotonin reuptake inhibitors,
Self-help groups 142, 144-5
Self-rescue technique 161
Self-suffciency, no such thing as 117
Seligman, Martin 125
Serotonin 75, 133-4, 136, 163
¡ N D E X 18;
Serzone 51, 53, 62-4
Sexual dysfunction as a side effect of anti-
Shift workers, sleep disruption among 93
Shopping, compulsive, as an addiction 41
Shyness, socializing easily in spite of 128
Sick-day arrangements for depression self-
care 165, 173
Side effects of antidepressants 47, 57-9,
benefts of exercise for 75
decline among moderns 5
deprivation 8, 23, 66, 89-92, 95, 138,
among caregivers 91
depression a factor in 95
occupiers as a factor in 141
physical discomfort as a contributor
that precedes depression 85
TV and the Internet as factors in 91
women suffer more from 89
as a maintenance operation 6, 88
older people’s needs for 89
people are clueless about their need for
tips from the National Sleep Foundation
Sleep Foundation survey 89
Smoking, depression’s link to 136-7
Snack foods, high-GL content in 102
Snacks, trans fats in 107
Social contact 6, 11, 21, 24, 67-8, 119, 122,
124, 139, 141-2, 149, 156, 159, 163-4, 169,
observations in Bowling Alone 122
quality levels of 126
suburbs discourage 120
urban changes discourage 120
Social pressure as a support mechanism
Social service as an antidepressant 130,
as addictive substances 138
as appetite boosters 99
depression’s link to 97
and triglycerides 106
Soybean oil 106-7
Specialists, mental-health, mediocre track
record among 50
SSRIs (selective serotonin reuptake
inhibitors), dangerious interactions of
grapefruit juice with 62
as emergency socilizing 171
meeting listings for 171
and powerlessness over alcohol 143
quitting without 144
Stewart, Martha 87
not an adequate explanation for depres-
compared with historical levels 42
overwhelming 161, 164
psychotherapy in the treatment of 67
as a trigger rather than an underlying
depression’s link to 2, 166
exercise as a preventive for 75
sleep deprivation linked to 89
Structure, importance of in
exercise program 77
pulling out of depression 165
social-contact increases 127
Subsidies, brain-chemical, addictive sub-
stances as 133, 138
as replacements for what you really need
and young adults 144
Sucrose 6, 138
3 million deaths a year attributed to 103
cane 97-9, 101, 106, 138
contributor to high cholesterol and
triglyceride levels 106
designer drug 100
UP W ¡ T H O U T ME D S 188
overdose in refned carbohydrates 101
pill 53-5 see also placebo
as self-medication 98
Sugar Mafoso 101
Suicide 12, 43, 47, 57, 59, 63, 89, 119, 166
Sunfower oil 107
Supermarket 109, 113-4
Supplements, dietary 24, 27, 114, 164
groups 66, 159, 173, 181
social 11-3, 29, 43, 46, 52, 54, 68, 70,
78, 96, 119, 132, 145-6, 159, 172-4,
Sweets 3, 110, 132, 175
Symptoms, depression 26, 38, 49, 94
Taco Bell 108
Technology as a contributor to depression
Teenagers 9, 14, 73, 87, 89
America’s addiction to 142
Americas habit 73
avoiding when depressed 174
as a barrier to good health habits 142
and children 73
as a contributor to social isolation 122
the mildly depressing effect of 141
as an “occupier” 141
special lure of for depressives 142
third-ranking way to spend time 91
viewing proves people have no shortage
of time 153
withdrawal symptoms when deprived
Texas, University of 25, 74, 90
Thase, Michael 54
diffculties in achieving success with
as support in making changes 12, 68
cognitive behavioral 65
Time constraints as barriers to change
Titanic 32-3, 71
Tobacco 92, 136-8
Trans fats 40, 106-8, 110, 116
Treatment programs 142
TV, see television
Two-career households 124
UCLA 59, 118
Umbilical reattachment, addiction as 136
Unbalanced brain chemistry resulting
from an unbalance life 1
Undersleeping as a contributor to depres-
Unintended consequences of progress 8
Unproven treatment fads 10
Upwithoutmeds.com 22, 161
Vegetables 23, 40, 43, 69, 99, 110-3
Vegetarian dishes 113
Vicious circles 29, 33-4, 72, 150
Video games 41, 73, 141, 175
Virtuous circles 29, 96, 112
Walnut oil 107
Waters, Alice 19
Web surfng 91
Wellness practitioner 182
Western-style diet 110
White bread 101
White rice 103
Wisconsin, University of 35
World Health Organization 47, 62
Yale 25, 73
Wh e r e A r e t h e no t e s
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at the back of the book, to the superscript numbers (such as
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I grew up in the beautiful foothills of southern Ohio, the son
of a dentist and a high-school English teacher.
In 1965 I received an A.B. in philosophy cum laude from
Harvard. For the next twenty-four years I earned my living
as an advertising copywriter, advertising agency executive,
Boston University lecturer, and educational designer.
In 1989 my wife Judy and I moved to Taos, New Mexico,
a mountain resort, where we founded a small chain of stores
catering to tourists. After losing almost everything in a clas-
sic entrepreneurial debacle, I began my process of recovery
from depression. My aim is to help as many people as pos-
sible, including you, eliminate depression from their lives.
Here’s the new research that
identifes the true cause of depression
and shows you the one way to beat it.
his could be the year you free yourself from depression and throw
away the pills. In this groundbreaking book, a Harvard-trained
scholar and former depressive presents a new nonmedical approach
to recovery that is safe, natural, and stunningly effective. You achieve
a full recovery, no matter how bad your genes, your childhood, or
your brain chemistry. Inside you’ll discover how to:
Find out what’s really been getting you down all your life
Overcome heriditary and childhood negatives to become even
more buoyant than those born with two antidepression genes
Control your mood, no matter what’s happening in your life
Optionally continue with meds or psychotherapy if you like
Pull yourself out of the spiral when you start to get depressed
Permanently improve your brain chemistry and outlook
Stay depression-free every day for the rest of your life
After 45 years of being trapped in depression, Mark Myers found
the way out. Curious if science could explain his recovery, he
discovered that recent studies didn’t just explain it. They pre-
dicted it. They showed that the most effective treatment for de-
pression isn’t pills or psychotherapy, but fve lifestyle decisions
that improve your brain chemistry and condition you against fu-
ture episodes. For extra protection, an emergency routine pulls
you out of a spiral if depression ever starts to come on again.
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